The Assembly met at 10.30am (Madam Deputy Speaker [Ms Morrice] in the Chair).
Members observed two minutes’ silence.

Local Government (General Grant) Order Northern Ireland 2001

Ms Jane Morrice: I wish to remind Members that a Statutory Rule which is subject to affirmative resolution becomes law once it is approved by the Assembly.

Mr Sam Foster: I beg to move
That the Local Government (General Grant) Order (Northern Ireland) 2001 (SR 395/2001) be approved.
This Statutory Rule is required in order to specify the district councils which are taken into account when determining the formula for distribution of the resources element of the general Exchequer grant. Members will be familiar with the financial support that the Department of the Environment provides for district councils in the form of this grant.
There are two elements to the grant: the derating element, which compensates district councils for loss of rate income due to the statutory derating of certain properties; and the resources element, which provides additional finance to those district councils whose total rateable value per head of population falls below a standard determined by the Department.
The grant available for the current financial year is £25·7 million for the derating element and £19 million for the resources element. That is a total of £44·7 million. These funds are distributed to councils in accordance with the statutory formula which is detailed in the Local Government &c (Northern Ireland) Order 1972. As part of the methodology for the distribution of the resources element of the grant, the primary legislation requires the Department to set a standard rate each year. Any council that falls below that rate is entitled to a share of the grant. Councils above that level are not entitled to the resources element of the grant. To determine the rate, data for selected district councils relating to gross penny rate products and population are applied. The formula is very complicated.
The legislation also requires that the councils taken into account, and the calculation of the standard rate, are specified in an Order that is subject to affirmative resolution. Article 2 lists the 15 councils for which data was used to determine the standard rate for distribution of this year’s provision of £19 million. Article 3 revokes the Local Government (General Grant) Order (Northern Ireland) 1997 and the Local Government (General Grant) Order (Northern Ireland) 1998. All district councils’ accounts for both years have now been certified, and the grants have been paid. The approval of this Order is a necessary part of the methodology for distribution of the resources element of the general Exchequer grant for 2001-02. I commend the motion to the Assembly.

Mr Arthur Doherty: It is right that we should express satisfaction, as the Order goes some way towards easing the burden on councils, particularly those smaller councils that would have suffered most from the earlier changes proposed to the general grant. We are grateful to the Minister of the Environment and the Minister of Finance and Personnel for making those resources available.

Mr Sam Foster: I thank Members for accepting the motion. I am grateful that I was not asked too many complicated questions, because it is a complicated subject, as far as the formula is concerned. I commend the motion to the Assembly.
Question put and agreed to.
Resolved:
That the Local Government (General Grant) Order (Northern Ireland) 2001 (SR 395/2001) be approved.

Fishing Vessels (Decommissioning) Scheme (Northern Ireland) 2001

Ms Jane Morrice: I remind Members that a Statutory Rule which is subject to confirmatory procedure becomes law once it has been laid before the Assembly. However, it ceases to have effect unless it is approved by the Assembly within a specified period. This Statutory Rule was made on 5 October 2001 and will expire on 28 December 2001 unless approved by the Assembly.

Ms Brid Rodgers: I beg to move
That the Fishing Vessels (Decommissioning) Scheme (Northern Ireland) 2001 (SR 349/2001) be approved.
I am introducing the scheme to help in the conservation of fish stocks by seeking to reduce the catching capacity of the local fleet. Under the scheme, and with the co-operation and assistance of my Colleague, Mark Durkan, I am making available £5 million in decommissioning grants to Northern Ireland fishermen.
I shall highlight briefly the key aspects of the scheme, which have been the subject of full consideration by the Assembly’s Committee for Agriculture and Rural Development and industry representatives. Launched on 5 October 2001 with a closing date for applications of 15 November 2001, the scheme was open to vessels over 10 metres in length that were registered as UK fishing vessels based in Northern Ireland since 1 January 2001; which had a licence authorising fishing in EC waters for any of the sea fish for which the UK has a share of EC total allowable catch; and which recorded at least 75 days at sea in each of the two calender years 1999 and 2000.
Vessels also had to be at least 10 years old, with a valid safety certificate, and they had to be in the same ownership at the time of application as on 1 January 2001. The scheme provides for grant aid to be awarded in respect of two classes of vessels — those targeting white fish stocks, which will attract three-quarters of available funds, and those primarily targeting nephrops, which will attract the balance.
Applications will be considered as part of a competitive tender process. A strike price mechanism will be applied to each class of vessel to obtain best value for money from the reduction of the fleet capacity. Successful applicants will be allowed to dispose of, or transfer, their fish quota entitlements to another vessel owner or to a fish producers’ organisation, and vessel owners have up to three years to complete the transfer. The principal means of disposing of decommissioned vessels will be scrapping; however, my Department will consider other methods. Interest has been expressed in the scuttling of vessels to create artificial reefs, and, if necessary, I will amend this Order to accommodate that method. However, I foresee environmental difficulties, which the fishing industry would need to resolve urgently.
Successful applicants will be expected to have decommissioned their vessels and surrendered all licences and entitlements before 31 March 2002. We aim to inform applicants of the result of their application before the end of the year, so that they have the maximum amount of time to arrange for the disposal of their vessel. The scheme is a key part of a £21 million aid package, which I am making available to the Northern Ireland fishing industry in recognition of the difficulties that it faces. Similar schemes have been introduced in England and Scotland. I commend the scheme to the Assembly.

Rev Dr Ian Paisley: Local fishermen welcome the launch of the Fishing Vessels (Decommissioning) Scheme (Northern Ireland) 2001, and they wish it well in its progress through the Assembly. Of course they feel that the scheme suffers from many imperfections, which have been well documented and debated. I would like an assurance from the Minister today that she will work closely with the fishermen so that matters can be ironed out during the scheme’s application. I also welcome the fact that she has left open certain methods of doing away with decommissioned vessels.
As Chairperson of the Committee for Agriculture and Rural Development, I will discuss our formal deliberations with the Minister on the matter. The Committee was informed of the Department’s proposals for a decommissioning scheme in October 2000, and it discussed the issue with officials in March 2001. In April, the Committee obtained a copy of the draft regulations and sought the views of the two fish producers’ organisations. Their members are directly affected, and many hope to leave the troubled and seriously run-down industry. The Committee then met with the Minister to discuss the issues raised by the fishermen.
As the Minister knows, their main concern was that the draft scheme did not allow for track records to be retained for use by the remaining Northern Ireland fleet. The track record displays fishing quota units and is attached to a vessel’s fishing licence. Fishermen had asked that the fish quota from a decommissioned vessel be returned to the producer organisation of which that vessel’s owner had been a member. In that way, the quota would stay with the remaining Northern Ireland fleet. Officials from the Department of Agriculture and Rural Development had assured them that that would be the case. The Committee agreed that that was essential to help sustain those vessels whose owners still wanted to fish.
Unfortunately, the Minister informed the Committee that despite that being the Department’s preferred option, according to legal advice the Department could not go down that road. Owners of decommissioned vessels would therefore be free to dispose of their track record to the highest bidder. There followed a period of further correspondence and meetings between the Committee and the Department. Although Members did not see the legal advice that was given, they were able to consider several policy papers. These were supplied on 5 July. The next day the Committee agreed that the Department of Agriculture and Rural Development should proceed with this rule. The Department consulted the fishing industry further during the summer, and the fishermen’s organisations raised more issues with the Committee.
The Committee met officials shortly after the summer recess and agreed to make several recommendations to the Minister, including the length of vessels to be included in the scheme and the use of certain statistics when considering applications from fishermen. The Committee was pleased with the Minister’s positive response, and the Statutory Rule was finally laid on 26 October. After formal consideration on 9 November, the Committee agreed to recommend that the Rule be confirmed by the Assembly.
More than 60 owners have applied to decommission their vessels. It is sad that fishermen feel that they have no option but to abandon their life’s work in that way, but it is also understandable. The savage quota cuts recently proposed by the European Commission represent yet another hammer blow to the industry.
The Deputy Chairperson of the Agriculture Committee, another Member appointed by the Committee and I will today go to Strasbourg to meet MEPs and Commissioner Fischler on this very important matter. The Minister has expressed her thanks for our attempt to lobby for her proposals. I trust that her advocacy, as well as our own, will meet with some success and that part of the dark shadow that hangs over the industry may be lifted. The scheme introduced by this Statutory Rule — assuming it is confirmed by the Assembly — will at least allow some owners to leave the industry with their dignity intact.

Mr Eamonn ONeill: I know that the Minister, along with Members who have witnessed the troubles of our fishermen, shares our deep concern for the welfare of those men and their businesses. As the Chairperson of the Agriculture Committee said, this Rule will offer an opportunity for some people at least to leave with some dignity.
We have observed the plight of the fishing industry over the years, and we have seen how people have attempted to deal with the difficulties. On many occasions we have lobbied with the Minister and in Europe for a solution.
The quota system and the new quota levels have effectively strangled the fishing industry, particularly in my constituency. Many people see those quotas as being excessively severe, and share a sense of injustice. While we are conscious of the environmental impact of overfishing, and while we are concerned about the future of the industry, it is indeed arguable that the quotas are excessively severe. I wish those who are lobbying for improvement every success in their endeavours.
Can the Minister give us any further information on the implementation of the scheme? Does the Department have any further plans to deal with the problems confronting the industry?

Mr Mick Murphy: Go raibh maith agat, a LeasCheann Comhairle. This is a serious problem. I welcome the Minister’s allocation of £21 million in aid for the decommissioning of boats. However, many people have been made redundant. Quota cuts on sole, plaice, herring and nephrops in the Irish Sea run contrary to scientific and fishing industry advice. Scientists specialising in the fishing industry proposed an increase of 90% in the Irish cod total allowable catches (TAC) of Irish cod, but the European Commission has restricted that to 10%.
Last year nephrops with a value of £8·5 million were landed from the Irish Sea, mainly for Northern Irish-based processors. A 25% cut will see the value reduced by £2·1 million. At the same time the value of whiting landed from the Irish Sea was £389,000. In other words, local fishermen are being asked to sacrifice at least £2·1 million in the name of rebuilding a stock that was worth 4·5% of the value of nephrops.
Despite being given the necessary evidence, and despite strong representation by UK Fisheries Ministers, the European Commission has refused to keep its commitments and restore the cut imposed on the out nephrops quota to 10%. There is no problem with the nephrops stock in the area 7 management area, which includes the Irish Sea.
Scientists have confirmed that there is a problem with their advice, in that it is retrospective. Therefore, their advice cannot take into consideration the additional technical conservation measures proposed and adopted by local fishermen from 1 January 2001. Those measures were designed specially to reduce discards of whiting and other stocks.
Fishing organisations believe that the EC’s judgement on quota management issues is being clouded by the personalities and ego trips of the few individuals involved. Evidence will show that stocks are high enough to allow fishing in the preserved areas. The European Commission has chosen to ignore the scientific evidence and continues to place fishermen’s livelihoods at risk.

Mr Kieran McCarthy: Our fishing community has experienced years of decline and cutbacks, which have had a severe knock-on effect on our fishing villages and further afield. Coming from a constituency that has a fishing community, I have seen at first hand the devastating effect this has had on many people. Let us hope that we will soon see an end to the uncertainty, and that the industry can get back on track to a prosperous future.
I pay tribute to all those engaged in the industry — which is a tough profession — for their forbearance and endurance. I am happy to support the motion, as long as it adequately meets the needs of the fishing community. I ask the Minister to work closely with, and listen to, the fishermen.

Mr P J Bradley: I welcome the Minister’s statement and the key aspects of the scheme that she outlined. It has been pointed out by other Members that it has been a long-drawn-out process since we first met with fishermen to discuss their plight. The Committee and the Department have had a good working relationship on this issue, as we fully realised the serious situation that the fishing industry was in. It was sad to see elderly men representing the industry coming to the Committee and not knowing where they were going to turn. Would their families survive in the industry that their grandfathers and great- grandfathers had set up? We felt that they were faced with an impossible situation, because the bureaucrats in Europe were dictating their lifestyle.
Yes, there are disadvantages in the scheme. However, I must go along with the opinion of the Anglo-North Irish Fish Producers Organisation that the need to proceed with decommissioning outweighs the scheme’s disadvantages. I welcome that line. They are the experts, and they probably appreciate that the fishermen cannot get 100% of what they were looking for. The advantages must be welcomed.
Another point is the possible reclamation of grant money paid in the last five years to fishermen who are decommissioning. I hope that a mechanism can be put in place so that any grant reclaimed from successful applicants is redirected into the industry. Ring-fence it, hold it, put it in savings, but get it back into the industry, rather than into some other Department or some unknown account.
The Chairperson said that it was ironic that on the day when we have firmed up some reasonably good news for the industry on decommissioning, we are now faced with the problem of the new quotas on prawns and haddock. The new demands that have been handed down from Europe must be challenged. This is D-day as far as the fishermen are concerned. I agree with the Committee’s decision to go and lobby the Commission and to support the Minister as best we can. We are united on the issue of cutbacks, and it must be fought tooth and nail.

Ms Brid Rodgers: I thank the Members for their contributions. I assure the Chairperson of the Agriculture and Rural Development Committee, Dr Paisley, that I will continue to work closely with the fishermen and consult them on all issues. The issue of scuttling of vessels is difficult, because of the environmental considerations. It would be difficult for the fishermen to scuttle their vessels in a way that would not damage the environment. However, I will examine it, and if a way can be found, I will deal with it in the legislation.
The Department would have preferred to retain the fixed quota allocation in the North. However, we did not have that option, as the legal advice indicated that it was not possible. I was pleased to respond to the Committee’s suggestions and make some minor amendments to the decommissioning scheme. I welcome the fact that members of the Committee will be going to lobby the Commission in Europe. The fishing industry is in a serious situation, and the proposed cuts are draconian. It will be useful for the Commission to understand that there is a united voice coming from all the parties in Northern Ireland in support of my attempts to ensure that the cuts are not as drastic as proposed.
Éamonn ONeill requested further information about schemes. I am pleased to announce that four schemes, in addition to the decommissioning scheme, will be open for applications from Monday 7 January 2002: improvement of facilities at Northern Ireland fishing ports, aquaculture processing, marketing of freshwater and marine products, and promotions.
That represents a total funding allocation of £15 million, £11·35 million of which is derived from the European Union. The aim of the schemes to improve port facilities will be to encourage the provision of safe, modern and well-maintained harbours and infrastructure at Northern Ireland Fishery Harbour Authority harbours.
The aim of the aquaculture scheme is to encourage the expansion of aquacultural production in Northern Ireland, to broaden the base of cultivated species, to exploit untapped market potential through the cultivation of high-value species and to increase quality through improved production methods.
The processing and marketing of the freshwater and marine products scheme is aimed at encouraging innovation and investment in the fish processing sector, to enhance market opportunities for primary producers and to increase the competitiveness of the participating businesses. The aim of the promotion scheme is to develop improved marketing structures and strategies by encouraging greater integration and collaboration among producers, processors and others in the fish processing and supply chain.
A total of £9·4 million will be made available to improve facilities at the ports, of which £7 million is European Union aid and £2·4 million is national aid. A sum of £1·2 million will be made available for the aquaculture scheme, £1 million of which is European Union aid and £0·2 million is national aid. Some £1·9 million will be allocated for the processing and marketing of the freshwater and marine products scheme, £1·6 million of which is European Union aid and £0·3 million is national aid. The promotion scheme will receive £1·75 million of European aid and £0·45 million of national aid — a total of £2·2 million.
I must correct Mr Mick Murphy’s interpretation of the figures. The total allocation for the various schemes is £21 million, of which £5 million is to be used for the decommissioning scheme. However, I agree that this year’s proposed cuts are a cause for concern, given that the industry has already suffered a great deal, especially as a result of the cod recovery plan.
Mr Murphy said that the Commission ought to ignore the scientific evidence. However, the Commission should, just this once, agree with the scientific evidence. The problem is that, in previous years, the Commission said that it had to act in accordance with scientific advice. When scientists advised the Commission to make cuts, it did so. This year, the scientists have advised us to increase the cod quota to 4,000, and I hold firm to that advice. The Commission, however, has proposed a swingeing cut. The same applies to quotas for other species of fish: scientific evidence indicates that there is room for an increase in the tack, yet the Commission takes the opposite view.
I want the Commission to be consistent. In the past few years, the Commission told us that it had to act in accordance with scientific advice to make drastic cuts. However, I cannot understand its position this year, because the evidence indicates that an increase in the quota is possible. It is ignoring the science and opting to impose cuts instead of increases.
I agree with Mr McCarthy that uncertainty abounds in the fishing industry, and there are many difficulties. He comes from a fishing constituency, so he will have first-hand knowledge of those difficulties. He has asked whether I shall ensure that the needs of fishermen will be adequately addressed in the decommissioning scheme. The scheme is a response to a request from the fishermen. I hope, therefore, that they can avail themselves of it. We have already received 66 applications for decommissioning. Provided that the strike price is agreed, we hope to be able to inform the successful applicants by mid-December. I expect that between 20 and 30 of those 66 applications will be successful.
I agree with Mr Bradley’s remarks about the difficulties fishermen face. The grant money about which he asked is EU money, and the Department of Agriculture and Rural Development has investigated the possibility of retaining that money. However, I regret to inform Mr Bradley that the Department was unsuccessful in doing so. It would have been nice to retain the money, but we have been informed by the EU that that will not be possible.
I thank Members for their contributions, and I thank the Committee for its co-operation in bringing the scheme forward. It was a complicated scheme and one with which the Department encountered several legal difficulties.
Question put and agreed to.
Resolved:
That the Fishing Vessels (Decommissioning) Scheme (Northern Ireland) 2001 (SR 349/2001) be approved.

Budget 2002-03

Mr Mark Durkan: I beg to move
That this Assembly approves the programme of expenditure proposals for 2002-03 as set out in the Budget laid before the Assembly on 3 December 2001.
Today the Assembly will vote, for the second time, on a Budget as envisaged in the Good Friday Agreement. The Budget sets out the spending plans that will deliver the commitments set out in the Programme for Government, which was agreed by the House after constructive debate yesterday. As I explained in my statement last week and in opening the Programme for Government debate yesterday, the Executive have had more time this year to ensure that their spending plans are based on informed and objective judgements.
The Assembly and its Committees have played a full and constructive role throughout the process, which began in June with the publication of the Executive’s position report. That position report provided Committees and the wider community with a long period in which to reflect and comment on the issues facing the Executive across all their major programmes and priorities.
The Executive took careful account of the responses received, and the draft Programme for Government and Budget presented to the Assembly in late September sought to address those. Since then, the Executive have had a more formal eight week consultation. We welcome the positive way in which Statutory Committees and others have used that opportunity to question and analyse the many spending issues that we face. In that context, I pay tribute to the lead given by the Committee for Finance and Personnel, which has drawn together the views of all the Committees. That has been helpful to the Executive, and I am sure that Members will agree that it has been especially helpful to the Assembly.
I made a comprehensive statement on the revised Budget to the House last week. As only a limited amount of time is available for debate, I do not wish to take up an undue amount of time going over all those issues or going through the departmental allocations again.
However, I wish to emphasise a few key points. I hope that it is now clear that the Executive listen and respond to what they hear. Their consultation has not been shallow or perfunctory. We have heard what so many in the House, and in society, have had to say about the need to do more for the Health Service, and we have acted.
Including the Executive programme fund allocations that I announced last week and the new money announced by the Chancellor in his pre-Budget report, we are providing an extra £41 million over and above the amounts that were announced in the draft Budget.
We are also acting quickly by adding £8 million to the Department of Health, Social Services and Public Safety’s budget this year instead of holding that amount back until 2002-03, as was indicated in the draft Budget. As a result, the allocation for health in 2002-03 will be £72 million higher than was envisaged in June’s position report and, in total, will involve an increase of £205 million, or 8·9%, in the current year’s figure. Although most of that money will be needed to cover rises in the costs of providing services, it will allow some £41 million of service development to take place in health and personal social services next year. That is out of a Budget that will total £2·5 billion.
Such resolute action shows the Executive’s determination to make a difference to the way in which society is governed and, more importantly, to the lives of its people. We will be forward looking but realistic as we plan for the future. We shall not be able to deliver the real improvements to achieve the quality of life that we desire, especially to those whose need is greatest, without facing up to some hard choices in future.
As I said last week, the devolved Administration had the good fortune to come into office when spending was growing rapidly. We cannot expect that to continue, and we need to be able to adapt our ways of acting to deal with a different situation. The Executive are determined to use next year’s spending review to make a clear and significant difference to spending on Northern Ireland’s public services. That will be a fundamental spending review, a root-and-branch analysis of where need is greatest and an opportunity to make our mark on the public services.
Last week’s statement gave rise to a range of important questions from Chairpersons of Committees and other Members. At the time, I sought to address those as fully as possible within the time constraints. However, two matters have since arisen that require further clarification. First, the Chairperson of the Committee for Social Development wrote to me as a follow-up to a question he raised after my statement. Specifically, he asked for an explanation of the adjustments that have changed the Department for Social Development’s expenditure limit. It was £450·5 million in the draft Budget and is £449·7 million in the revised Budget.
Three adjustments were made to the total for the Department for Social Development between the draft and revised Budgets. The first was the addition of £2·9 million of welfare-to-work funding that is a technical change in the presentation of the figures to reflect the fact that that expenditure now forms part of Northern Ireland’s assigned departmental expenditure limit, so it is within the resources that are allocated at the discretion of the Executive and the Assembly. Corresponding presentational changes have been made to other Departments’ totals.
Secondly, there is an increase of £1·6 million, which is the Department for Social Development’s share of the Executive programme fund allocations that I announced last Monday. Against those additions to its departmental expenditure limit, the Department for Social Development has identified a reduction of £5·4 million in the provision required for the Laganside Corporation. That change to Laganside Corporation reflects a technical change to the treatment and classification of aspects of its finances without altering its actual activities.
The Department for Social Development notified the Department of Finance and Personnel that £5·4 million less than had been allowed in the draft Budget was needed from the departmental expenditure limit to finance the planned level of activity. That reduction, reflected in the revised Budget, is due to a clarification by the Department for Social Development of the amounts required from the departmental expenditure limit to provide for Laganside Corporation’s planned activities.
To show such a reduction as a reduced requirement is in line with resource budgeting practice. It released spending power within the departmental expenditure limit for reallocation to other services, and did not reduce the spending power of either the Department for Social Development or Laganside Corporation.
The same technical correction applied in 2001-02 also, with £5 million being returned in monitoring rounds. However, in Budget presentations, it is normal practice not to include in-year changes such as the routine monitoring round reallocations in the comparative figures used in the Budget document.
Therefore, with the £5·4 million reduction applied in 2002-03, but not the £5 million reduction that is shown in the comparative figures for 2001-02, there is an apparent 9·9% reduction in that spending area. That is not the whole story, or the actual spending facts, as it is not possible to show every change in the Budget document. We consistently use comparisons that exclude monitoring changes, because that minimises distortions and provides the best like-for-like comparison between one year and the next, even if it gives rise to possible misinterpretations.
The Minister for Regional Development has written to me asking about the impact of the Chancellor’s decision to phase in the introduction of the aggregates levy. According to the Department for Regional Development’s own provisional assessment, that will lead to a reduction in the amount of levy that the Department will be required to pay, which will be approximately £2 million. As I indicated in the Chamber on 3 December, and as I advised the Committee for Finance and Personnel on 4 December, the Executive are content that the Department should retain that sum for use in the roads programme. The draft Budget included a specific addition of £7 million to help mitigate the impact of the aggregates levy on the roads programme.
It would be valid for the Executive to use the £2 million easement elsewhere, perhaps in the area detailed in the amendment. Unlike those who support the amendment to the agreed revised Budget, the Executive honourably concluded that we should sustain the agreed allocation for the Department for Regional Development as an important service. The amendment is a cynical gesture against the agreement. It has nothing to do with addressing the problem of fuel poverty and everything to do with undermining the agreement and necessary public services.
The North/South bodies are an essential part of the agreement. The Assembly and its institutions are interdependent. The creation of bodies to implement some public services on a cross-border and all-Ireland basis is a central and positive development that recognises the nature of the political and institutional settlement. It also recognises and pursues the mutual benefits of co-operation.
The Assembly is obliged, under international law and the North/South Co-operation (Implementation Bodies) (Amendment) (Northern Ireland) Order 1999, to provide for those bodies as necessary public functions.
Far from cutting the budget for the Office of the First Minister and the Deputy First Minister, the Committee of the Centre has argued consistently for additional resources to enable that Office to fulfil essential services, including action on matters such as a children’s commissioner and the review of public administration. No doubt Mr Poots and other Members will contribute to the debate. When I presented the draft and revised Budgets, he complained that the Office of the First Minister and the Deputy First Minister was not getting the allocations that it needed to carry out its services. The same Mr Poots will no doubt speak vociferously in support of the amendment, which seeks to further reduce that office’s allocation.
The Executive agreed an appropriate allocation for the Department for Social Development as part of the revised Budget proposals. From that allocation, the Minister must propose the Department’s priorities. It is striking that the warm homes scheme was not a proposal in the June position report by the then Minister for Social Development, Mr Morrow. It is clearly hypocritical for anyone now to pretend that it is the Department’s biggest priority. In last year’s December monitoring round, the Executive provided £2 million for fuel poverty in 2000-01, and that allowed the scheme to proceed in July.
It was the Minister for Social Development who chose to reduce the Housing Executive’s rent increase last year. That was his choice. However, it meant that less money was available for his Department’s budget, and not least for housing. In effect, we handed £2·8 million back to the Chancellor of the Exchequer, because housing benefit covers 80% of Housing Executive rent. The Minister’s decision ensured that the Department would forgo money that could have been used for housing and programmes to alleviate fuel poverty, such as the warm homes measures.
The cuts to the North/South bodies’ budget that are proposed in the amendment would also ensure a real cut in necessary public functions. For example, if we deny funding to the Special EU Programmes Body (SEUPB), the new Peace II programme cannot be implemented on time. Furthermore, SEUPB will be unable to carry out its necessary work on other programmes. It would be unable to respond to the needs, interests and concerns of the many groups that want to take advantage of such programmes and who await their urgent delivery. The development of North/South trade is of economic benefit to all parts of the island, and to this region in particular. It is right and proper that it should be pursued.
The amendments are interesting in that they show a possible change in the DUP’s position. The party previously sought to strike out the North/South bodies completely, whereas today’s amendment seeks to cap and squeeze their budgets. I shall listen with interest to the Members who support the amendment. It may be that they are adjusting their position somewhat on North/South bodies. I note also that there is no move against the food safety body in the amendments. I await with interest the full explanation as to why the DUP now deems that board to be immune from its previous objections to North/South budgetary provision.
The allocation to the Foyle, Carlingford and Irish Lights Commission is for a new interpretative centre at its headquarters in the Waterside area of Derry. DUP representatives have complained that that area has been denied the necessary investment of public resources. However, the DUP tables an amendment that will strike against investment in that very location.
The Waterways Ireland allocation is for new premises in Enniskillen, which will bring up to 70 new and secure jobs to the area. Enniskillen is in the constituency of the Member in whose name the amendment is tabled. Therefore, several contradictions and some confusion has crept into the DUP position. Members await explanations with interest.
The revised Budget is a responsible Budget from a responsible Executive, which is in the business of delivering good government, rather than playing partisan politics. The Budget has to signal a further shift in historical patterns of public spending in Northern Ireland towards local priorities set by local representatives in response to local needs, concerns, and initiatives. The revised Budget, agreed by the Executive, represents another significant milestone on the road towards stability and normality. It will make a difference where the need is greatest. I commend it to the Assembly.

Ms Jane Morrice: One amendment has been selected, and it is published on the Marshalled List of amendments.

Mr Maurice Morrow: I beg to move the following amendment: At the end add:
‘subject to a reduction in the expenditure in the following spending areas:
£0·3 million
North South Body
Carlingford and Irish Lights
£0·2 million
North South Body
Languages
£0·4 million
North South Body
Waterways Ireland
£0·1 million
North South Body
Trade and Business Development
£0·2 million
North South Body
Special EU Programmes
£0·1 million
OFM/DFM
£0·05 million
Civic Forum
and requests the Minister of Finance and Personnel to consider the allocation of the resultant of savings to the Department for Social Development for the warm home scheme.’
I listened to what the Minister had to say, and I was somewhat disappointed that he did not try to deal with the real issues that are before the House today.
The Minister must accept, whether he likes it or not, that fuel poverty is a real issue. He may try to play it down and make light of it, as he did in his speech. However, I suspect that that will not make the issue disappear. In considering what people, right across the House, have been saying about fuel poverty, the Minister will find that there is a unanimous stance on tackling the issue.
Should the Minister take our advice and reduce funding on the items that we have selected, nobody will be hurt. If the amendment is carried, people in Northern Ireland, especially those who suffer from fuel poverty, will be much better off. I bring the definition of fuel poverty to the attention of the House. The commonly applied definition of a fuel-poor household is one that needs to spend in excess of 10% of its income on fuel to maintain a satisfactory heating regime. Some 170,000 households in Northern Ireland suffer from fuel poverty. Around 600 deaths are caused every year in Northern Ireland by cold-related illness. I do not think that any Member of the House would try to make light of that or say that we should not make an honest and determined effort to tackle the problem.
We recognise — not because we agree with it — that the bodies that we refer to are statutory. That was something that the Minister picked up on.
However, we simply said that the benefit would be much greater if the increases that were to be applied this year were withheld and directed to tackle fuel poverty.
The Minister was at some pains to outline the achievements of the cross-border bodies. The world outside has not noticed any of those achievements. Approximately £20 million will be given to cross-border organisations. We wait with bated breath to see what real benefit that will bring to the people of Northern Ireland.
I draw the House’s attention to the effects of fuel poverty. The principle effects are health-related. Children, the elderly, the sick and the disabled are most at risk. Cold homes are believed to exacerbate existing illnesses, such as asthma, and to reduce resistance to respiratory infections. In addition, households also suffer from opportunity loss, as they use a larger portion of income to keep warm, compared to other households. That has adverse effects on social well-being and on the overall quality of life for individuals and their communities. It is generally recognised that fuel poverty is a contributory factor to social exclusion.
No Member needs to be convinced about the need to tackle fuel poverty; some 600 deaths per year occur because of cold-related illnesses. Those figures stand out vividly and tell their own graphic story.
The Minister said that the Office of the First Minister and the Deputy First Minister needed funding for cross- border bodies. I am not quite sure what it is needed for, as we have not yet seen results from those bodies. The office always wants to be at the forefront when there is a good story to tell.
I suspect that the Office of the First Minister and the Deputy First Minister would not mind in the slightest giving up a small portion of its budget to facilitate the worthy cause of fuel poverty. When another Minister had a good story to tell, the Office of the First Minister and the Deputy First Minister rushed in to take the credit for it. I do not mind if it takes the credit in this case — I just want it to sacrifice part of its budget in doing so.
I draw the House’s attention to the comments of some Members who are genuinely concerned about fuel poverty. Mr Fred Cobain, Chairperson of the Committee for Social Development, said:
"The Assembly will not be surprised to learn that the Committee has again felt the need to register concerns about the proposed allocation of funding to tackle fuel poverty and housing needs. The Warm Homes Scheme is a one-off capital cost. It has no recurring implications. If it were to be properly and urgently funded, it would have positive effects not only on the standard of housing, but on people’s health and well-being. There would be consequential savings for the Department of Health. I urge the Minister of Finance and Personnel and his colleagues on the Executive to think long and hard about that."
Mr Danny O’Connor, speaking on 25 September, said:
"The Assembly must look at how it can eradicate the problem of fuel poverty."
The whole of Northern Ireland will applaud if the Assembly does nothing else but demonstrate clearly and unambiguously that it is determined to remove this problem.
The Minister also referred to the fact that rent increases were not as swingeing as in previous years. He is right, and I hope that the same attitude will be adopted this year. For too long those who live in social housing have had to pay. Why should they, more than anyone else, pay over the rate of inflation?
However, the Minister should have told the whole story of what is happening in housing. He did not say that £18 million was handed back as a result of house sales, and that is important.
I have listened carefully, and I ask the Minister to listen even more carefully. He could identify savings that would not hurt any of the Departments or anyone in Northern Ireland.

Dr Esmond Birnie: The Member has eloquently expounded the need for extra funds for the Department for Social Development. Will he confirm that the running costs of that Department are due to increase by £20 million next year? That offers plenty of scope for savings to deal with fuel poverty.

Mr Maurice Morrow: Whatever the increase, it is not enough to tackle existing fuel poverty. The Housing Executive plans to replace 677 Economy 7 room heaters in each of the next three years. To use the £1·35 million identified would mean accelerating that programme, ensuring that it was kept on course and tackling a further 670 homes next year. Areas have been identified which will ensure that no one suffers. No one can say that that would not be worthwhile or that it should be dealt with in any other way.
The Civic Forum has also been identified as a possible source of savings. Can anyone here point to one constructive thing — just one — that it has done since its inception? I suspect that that would be very difficult.
I look forward to the Minister’s changing his mind on this. I cannot tell him to do so, but I urge him to reconsider and to redirect funding for the replacement of Economy 7 heaters, thus ensuring that fewer people die this year.

Mr Francie Molloy: Go raibh maith agat, a LeasCheann Comhairle. I welcome this opportunity to speak. This is the Assembly’s last opportunity to influence the Executive’s spending plans for 2002-03. The Committee for Finance and Personnel led a take-note debate on the Budget on 5 November, and concerns were raised about allocations in the draft Budget proposals. The views of all departmental Committees on their proposed allocations had been sought before the debate, and I thank all Committee members for their useful contributions and their co-operation with the Committee for Finance and Personnel.
Following that debate, the Committee produced a report on the draft Budget with summaries of the views of other Committees as well as its own. Several improvements to the process were recommended, and that report was passed to the Minister and Members on 16 November.
On behalf of the Committee, I welcome the Minister’s positive response to the report in his statement of 3 December and his response to the Committee on the Executive programme funds on 4 December. I thank the Minister for addressing the recommendations that we made in the previous Budget report. He helped the Committees to begin to examine departmental spending plans, and that created a welcome opportunity for discussion about the Budget. It is helpful if Members have the opportunity to discuss the Budget in detail and begin to examine the departmental spending plans at an earlier stage.
I welcome the agreement that the Executive programme funds should be reviewed. That was recommended in the report. It is important that the funds are seen as cross-cutting measures that are designed for future development. If the funds are to be successful, they must be innovative and cross-cutting, and they need to set out a new plan. They must not simply regurgitate the different plans and bids that were previously put forward. I welcome the review, and I urge the Minister to ensure that it happens quickly.
The Committee recommended that the needs and effectiveness evaluations should inform the 2002 spending review negotiations. If an activity or target is identified in the Programme for Government, it should be funded through the Budget in a transparent way. Mainstream departmental priorities should be funded by the Budget; they should not be dependent on Executive programme funds or on the re-allocation of funding from another year. More fundamental and ongoing scrutiny of departmental activities and spending is needed, and that should be done through a cross-departmental approach. There should be early consultation between Committees and Departments on the development of position reports. That would facilitate more effective understanding of, and debate on, departmental spending plans.
It is unfortunate that so few Ministers are here this morning. It is important that we have greater correspondence between Departments and Committees, to provide the Committees with the information that they require. I urge the Committees to demand that information, so that future debates can be more informed. The information must be detailed if it is to form part of discussions. The Committees must be involved with their Department at an early stage to make the bids. From the point of view of a Minister or a Department, it can only be an advantage if the Committee supports a bid, rather than simply rubber- stamping it. A Committee should not wait for its Department to present its programme; it should be involved in scrutinising service delivery agreements (SDAs) and other financial and planning information in preparation for the Budget.
Executive subcommittees should be established as quickly as possible to manage the individual Executive programme funds. The subcommittee system is a way of dealing with the Executive programme funds, as it creates an opportunity to develop new ideas that may not otherwise be put forward.
The Minister has applied the tactic of forecasting end- year flexibility and allocating funds in advance, rather than in the coming year’s monitoring rounds. That is to be welcomed, if we are to see how Departments will perform and if we do not want simply to wait and see whether there is an overspend and then re-allocate it. The Committee thinks that that approach could be beneficial.
The Committee welcomes the approach that the Minister has proposed with regard to effectiveness evaluations. Making allocations in advance of the evaluation results creates uncertainty when Departments are planning their services. We urge the Minister and the Executive to involve Committees at an early stage of the preparation of the 2002 spending review.
I thank the Minister, working on his last Budget, for the effective way in which he has dealt with the Committee for Finance and Personnel and the jovial way in which he was able to cope with — at times — a great deal of criticism. He has always been good-humoured. I thank him for the discussions that he held with the Committee and the open and transparent way in which he dealt with us. It was a learning experience for all of us, but the Minister’s approach meant that we gained a better understanding. I look forward to working with his successor. I wish Mr Durkan all the best for the future and thank him for his co-operation. Go raibh maith agat.

Mr James Leslie: I would like to reflect on Mr Molloy’s remarks and on Mr Durkan’s opening words about the Budget process. We have developed a system of reading a draft Budget at the beginning of a session, having a full, detailed debate in the middle of the session, and presenting the final Budget at the end of the session. This is proving to be a good method of handling the Budget. It enables Members and Committees to have a proper input into the formulation of the final package, and gives them the scope to influence the outcomes. That is better than the "here is what you are getting" approach that tends to be used in other jurisdictions, where Members can merely complain on the day of the Budget, with no prospect of changing the outcome. The system that we have evolved is superior, and makes it easier for the Minister of Finance and Personnel to achieve the consensus that is necessary under our form of government.
One or two ideas were left hanging in the Budget presentation. The Minister said that there would be more focus on asset management as part of a move towards resource-based accounting. We still have some way to go, because we must achieve valuations of all assets that command confidence. The depreciation charges may take up a lot of our time over the next year or so; first, as we get to grips with seeing them in black and white, and, secondly, as arguments are raised about what rates of depreciation it would be appropriate for us to use. The matter exercised me considerably when we were dealing with the Government Resources and Accounts Act (Northern Ireland) 2001. It may exercise us again when we prepare the proposed audit Bill at the beginning of 2002. The House must have confidence in the conventions used.
I note that every opportunity will be taken to identify and dispose of surplus assets, and that the money thus raised will be available for additional spending. That move is welcome. During the debate on private finance initiatives (PFI) and public-private partnerships (PPP), it emerged that the Government have built up a huge portfolio of assets, particularly over the 50 years since the major expansion in the welfare state. It is not axiomatic that it is wise for the Government to manage such a large portfolio. A fresh eye must be turned on the matter.
The matter of the Government’s assets is one of the issues energising the PFI and PPP debate. The issue of services is part of that debate, but it is separate from this matter. Our early focus must be on how best the Government can manage their assets. Should they own as many as they do, or should they hire them as required? The advantage of that would be that such assets could be "un-hired"; if assets are owned, they must be disposed of or redeployed, which is not as efficient.
I remind the Minister that there are still problems in the Land Registry, which is in his own Department, and that this continues to be a source of concern for all those involved in the conveyance, mortgaging and financing of property.
Although we have been assured that those problems are being addressed, they have not been addressed in the Budget. It is supposed to be a self-financing process, but the Committee will have to keep a beady eye on that issue in the new year. I trust that the Minister or his successor will focus closely on the matter, and if further resources are needed, that that will be brought to the attention of the House sooner rather than later.
Although the Minister’s statement mentions that the issue of PFI and PPP is being examined, we continue to tiptoe around the matter. The Department for Regional Development has probably the greatest scope to make progress in that area, and it is best placed to apply the concept of "user pays". I have not noticed a single reference to those matters in any literature from that Department. Fresh thinking and political courage are needed if we are to go down any of those avenues. It remains to be seen whether the Minister for Regional Development will be willing to display the necessary political courage and ability to think "outside the box". Such thinking, and a preparedness to explore those avenues, is needed if we are to make a significant improvement, particularly in our transport infrastructure. When setting the Budget, it is important that the Executive are satisfied that such avenues have been exhaustively examined before they simply dole out more money for transport.
I will comment briefly on the amendment. My Colleague Dr Birnie rightly pointed out the substantial increase in the amount of money being allocated to the Department for Social Development this year. Furthermore, the Minister of Finance and Personnel also pointed out that money was reallocated within the Department. It is almost inconceivable that the Department would not be able to find a further £1·35 million from within its own resources for the warm homes scheme, should it seek to do so. If anybody needs to refocus priorities on that matter, it is the Minister for Social Development, who undoubtedly has the means to do that if he so chooses. Mr Morrow is not justified in trying to throw that burden back onto the Executive through this essentially mischievous amendment, which is designed to make a political point in another direction.
As regards the Foyle, Carlingford and Irish Lights Commission, I must point out that the body responsible for the Irish Lights does not only pre-date partition; it pre-dates the Act of Union. It is probably the longest standing British Isles body in existence — certainly on this island. As a practising yachtsman who has not totally mastered the use of global positioning systems and other such gadgets — I generally use a compass, a lighthouse and a bearing from the land — I am twitchy when any assault is made on the allocation of funds to the Irish Lights.
The Budget is a worthy and workmanlike allocation of the existing resources to the existing, mostly inherited, programmes. However, it is vital that we move towards some wider and fresher thinking next year. When we have done so, and given the context of the spending review that will take place over the coming year, next year’s Budget may well contain some surprises, which we should begin to prepare ourselves for. We need to begin to think differently about how money is allocated and what our priorities are. I trust that that will result in a lively debate on next year’s Budget — certainly at the take-note stage — as those changes which will be identified over the coming year are brought before the House. I support the Budget.

Mr Eamonn ONeill: I want to make some comments on behalf of my Committee, but before I do so, I thank the Minister for his clarity and information on the budgetary situation for social development. It is important to have that clarified at the outset. Indeed, I congratulate him on providing the extra resources in what was actually a tight expenditure round. It is important to put that on the record because the additional resource will be used effectively in areas that concern us all.
I also want to record the thanks of the Committee for Culture, Arts and Leisure to the Minister, the Executive, and the Committee for Finance and Personnel. Their combined efforts ensured that the budgetary process this time allowed Committees to carry out their scrutiny role more effectively than before.
Although my Committee welcomed the additional allocations for the Department of Culture, Arts and Leisure, totalling £7 million, we remain concerned about some serious aspects of underfunding that continue to inhibit the Department’s activities. One of these is in the area of sports, where funding — with the exception of a welcome allocation of £1 million earmarked to be spent on the continuation of the safety at sports grounds scheme — was disappointing.
The Programme for Government’s priority of working for a healthier people is not simply about the treatment of disease or the care of sick people. It is about persuading people to change their behaviour, which involves wide- ranging collaborative action across different sectors. This, in itself, puts paid to those simplistic budgetary arguments we have heard in the House this year about taking £10 million from each Department to support an increase in health spending.
Sport and physical activity have important roles to play in increasing health-related activity across all sections of the population. While this is especially true of lifelong participation in sport and exercise, it is equally important in helping to build self-esteem and increase social inclusion through leisure activities. A large body of evidence shows that lifelong involvement in sport and physical activity can bring significant health gains for everyone, and also helps with mental health. Recent research in Northern Ireland has stressed the importance of physical activity to the mental health of our young people, and the strong associations between participation in sport and positive mental health.
We all feel deeply about the tragic loss for families and society when a young person takes his own life. Sadly, in Northern Ireland this is a trend that has caused great concern and seems to be on the increase.
These are just a few indications of the convincing evidence supporting the need for continued and enhanced investment in sport. The Committee hopes that the connection between sport and policy objectives across a range of Executive functions will be properly recognised in future resource allocations.
We similarly have concerns about the success of the Department’s arts bids, which total something in the region of £4 million. This means that there is no additional money next year for a sector that already needs capital investment in a crumbling infrastructure.
I appreciate that the arts fared relatively well in 2001-02 and that additional moneys allocated then have been carried forward in the Budget. However, we are lagging far behind arts budgets elsewhere, particularly the Republic of Ireland.
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We are also trailing behind the Republic when it comes to events. Next year’s budget for the Northern Ireland Events Company is just £1 million. Two years ago the Government in the Republic allocated an additional £2·5 million for three years just to attract extra events. That money was additional to the support already given for four major golf events and many other cultural, arts and sports events. For example, they have put between £7 million and £8 million into staging the 2006 Ryder Cup. That investment, they claim, will bring at least £50 million — and probably closer to £100 million — in return. With an annual investment of only £1 million, we are not really in the game at all.
The Committee is also concerned about the continuing neglect of the fabric of our museums and the Armagh Observatory and Planetarium. In 1994, the budget for museums was cut by approximately 8%, and that situation has not been rectified. Additionally, it is simply indefensible that funding for Museums and Galleries of Northern Ireland (MAGNI) continues to be addressed by our annual battle for adequate baseline allocations. Given that MAGNI has already accumulated a deficit of approximately £2 million in the current year, the Committee argues that the position must be addressed in the following spending review.
More positively, we warmly welcome recognition of the difficulties that the Department of Culture, Arts and Leisure faces on the staffing front. The allocation next year of £2 million for administration will enable the Department to create a corporate structure and thereby improve its services to customers, including the Assembly.
I am conscious that I have said this on other occasions, but it is a point worth making again. Very small amounts of money, which could well be lost in the rounding of amounts by other big-spend Departments, would go a long way towards addressing many of the issues that I have mentioned and would bring significant benefits to our community.
I wish to make a couple of points on my own behalf about the amendment. Its thinly disguised attempt to attack the agreement is clear. At least the DUP has been consistent from the outset in its frantic attempt to undermine the will of the people. However, it is exploitative to use emotional subjects such as fuel poverty to try to win public acclaim and support. Many Members realise that moves on fuel poverty are necessary, and they want to support them.
It is amusing to hear the proposer of the amendment talking in such terms. When he came to the Committee for Social Development as Minister, I put it to him that he might consider an alternative method of ensuring that the resources, inadequate as they are, could be applied more directly to those who need them most. By that I mean that scattergun efforts are made to address fuel poverty. At Christmas everybody over 60 years of age gets a cheque for £200, including one chap I know who is a millionaire. He does not need the money; but I know others who could do with double that amount and more. Why can we not tackle the issue by directing resources where they are needed?

Mr Sammy Wilson: The decision to give £200 at Christmas was not made by the Assembly or the Minister for Social Development. That initiative came from Westminster.
(Mr Speaker in the Chair)

Mr Eamonn ONeill: As the Member knows, I am well aware of the point behind his interjection. I serve this as an example of the scattergun effort that is used to deal with the matter. There are other means of tackling the issue, and when I put that to the former Minister he said that he would examine it, but unfortunately that was the last that I heard about it. At that time he was in a position to do something directly about it. He did not do so.
He said that nobody would be hurt by the reduction of funding for cross-border bodies, one of which is a language body. Has the former Minister not been aware of the recent growth of confidence and status of the Ulster-Scots community and language? He should talk to that community, because many of his Colleagues would argue in support of them. Does he suggest that Ulster-Scots should be set back? That is what he will do if he cuts the Budget to such an extent.

Rev Dr Ian Paisley: Does the hon Gentleman suggest that the Ulster-Scots language should be on a par with the Irish language and that it should get the same amount of Government money to forward its interests?

Mr Eamonn ONeill: I am not certain of the Member’s point, but the confidence and status of Ulster-Scots is being increased tremendously as a result of the languages body’s work. Any reduction in its budget would affect that. Perhaps Dr Paisley wants us to introduce that old DUP exclusive policy whereby we cut the budget for the Irish language only, although I am not certain. Another particular example from my area is the Ulster Canal. [Interruption].

Mr Speaker: Order. I draw to the Member’s attention that this is a time-limited debate. A substantial number of Members wish to address the matter, and at this stage, apart from the proposer, Mr ONeill has been on his feet for more time than any other Member. I ask him to bear that in mind. Members who use interjections, but who also hope to be called to speak, tend to use up the time available. I ask the Member to bring his remarks to a close.

Mr Eamonn ONeill: Perhaps I am long by nature also. I will draw my remarks to a close. I use the example of the budgetary cut to Waterways Ireland, which runs the Ulster Canal project. That is a long-term project that was fully supported by every party in the Chamber. The scheme would have a tremendous impact on urban and rural regeneration for areas that otherwise would not benefit in that way. When he talks about the need for cuts in that area, he should tell us how he proposes that that be done. We all know that this is a thinly disguised attempt to attack the agreement once again.

Rev Dr Ian Paisley: As Chairperson of the Committee for Agriculture and Rural Development, I sound a warning about the Budget before us today. The final budgetary allocation to the Department of Agriculture and Rural Development is unchanged from the draft Budget that we debated in November. I spoke then of the Committee’s concerns about the lack of new progress for the implementation of an action plan, as the agreed Programme for Government promises the strategic development of the agrifood industry. Those concerns remain with us today. They were not allayed by the report by the Minister of Finance and Personnel about provision for the findings of the vision report.
He said that when the current consultation process is complete, the Minister of Agriculture and Rural Development would publish an action plan. He went on to say that at that stage firm bids for the implementation of recommendations could be considered, with access to the Executive programme funds as appropriate.
The Committee’s difficulties lie in the fact that bidding within that financial year will be very competitive and will be for very limited resources. The chairpersons of the vision sub-groups who met with my Committee emphasised that they were alarmed that after all that they had done, and the recommendations to be considered, no money was being made available at this time.
When I raised this matter in the Chamber on 3 December during the Minister of Finance and Personnel’s statement on the revised Budget, he repeated his assertion that the Executive would consider the need for resources following the outcome of the consultation. He said that
"People may have accused us of pre-empting the outcome if we had fixed a particular allocation." — [Official Report, Bound Volume 13, p195].
The Committee would not agree. Members feel that such a major commitment in the Programme for Government is worthy of an initial financial allocation at least.
Worse still, when the Minister of Finance and Personnel made a statement on the Executive programme funds on 3 December he said that the Executive were able to agree an allocation — which I understand is to be £1·6 million over three years — for the emerging soccer strategy. That strategy is also the subject of public consultation.
If the Minister can give assistance of £1·6 million to soccer during the consultation period, why can an allocation not be made for a very important programme that is needed to save the largest industry in Northern Ireland? I make no comparisons between the circumstances of one decision or the other, but there is an inconsistency between the wait-and-see principle for agriculture and the absence of such a principle for soccer.
The Assembly would agree that soccer, however enjoyable, is not as important to the Northern Ireland economy as the agrifood industry.
The Committee also recommended that the Executive should set aside additional funding this year for a compensation, or tie-up, scheme for fishermen when they are not allowed to use their vessels. This also falls under the wait-and-see banner, given that the Minister of Agriculture and Rural Development has undertaken to review the economic effects of the closure of fishing grounds over the last two years. The Minister tells us that following the review she will consider when compensation is appropriate. Although there has been no provision made in the Budget, I ask the Assembly to remember its unanimous support in March for the Minister to provide short-term assistance to the fishing industry.
There is more hardship ahead for fishermen. Decisions will be made next Monday that could cut the income of the fishing industry by over £1 million. A delegation from my Committee, and our three MEPs, have secured a meeting tomorrow afternoon with the European Commissioner, in an effort to alleviate some of the savage cuts proposed to the fish quota by the European Commission. The Committee remains convinced that the sustainable and competitive fisheries industry mentioned in the Programme for Government must have short-term assistance to ensure that it is maintained. The Assembly needs to play its part in that.
The Committee is disappointed at the outcome of both the Budget and the Executive programme funds. Time will tell if those concerns are justified, but farmers, fishermen and other rural dwellers will understandably feel let down if good intentions fail for lack of financial planning.
I will now lay aside my hat as Chairperson of the Committee for Agriculture and Rural Development and make a comment on the amendment that is before the House. I regret that the Minister of Finance and Personnel has tried to mislead the House on the motivation and the reason for the amendment. We tabled a series of amendments along the lines that we have advocated in the past. I do not know how much power the Minister of Finance and Personnel has, but it is very difficult to get any amendment tabled in this House.
We were told last night by the Business Committee that our amendments would not be taken. The Minister of Finance and Personnel suggests to the House that the DUP’s stand is weakening. Everybody knows our stand against the Belfast Agreement perfectly well. As a party leader, I am deeply resentful that a last-minute decision was conveyed to us that none of our amendments would be taken. Eventually we were told that one of them would be taken, if it were revised. For the Minister to suggest —

Mr Speaker: Order. I advise the Member to be careful about some of the remarks he is making in respect of the amendments. To my certain knowledge, they are incorrect — to my certain knowledge, they are incorrect. It may be that there is misunderstanding in the House, or it may be that there is misleading going on. The Member should also know that according to Standing Orders, no decisions on amendments can be made before 9.30 am.

Rev Dr Ian Paisley: That is a matter for those who sit on the Business Committee —

Mr Speaker: Order. I am astonished, because the Member is well known throughout these islands for his knowledge of matters such as Standing Orders. The matter is very clear, and he knows well that it is for the Speaker to decide on amendments. The account that he gives of some of these matters is not correct. It may be wise for him to check with some of his Colleagues.

Rev Dr Ian Paisley: I stand over what I have said. That was the information given to me by my Chief Whip —

Mr Speaker: Order. The Member must be careful about what he is saying. He is coming in contempt of the Chair, and I will simply bring his speech to a close if he goes any further. What he has said is not the case. If he has been misled by one of his party Colleagues, that is a matter for him and his party Colleagues. I know how those decisions are made and what the situation is. They are decisions made by me.

Mr Maurice Morrow: On a point of order, Mr Speaker. Can you confirm that three amendments were put down?

Mr Speaker: I can confirm that three amendments were put down, and I can also confirm from the start that I made it clear that amendments that were not competent would not be accepted. It is also the case that my Office, on my advice, gave assistance in making an amendment competent, which it had not been. It appears, however, that no good turn goes unpunished as far as my staff is concerned.
Dr Paisley may continue if he wishes, but the matter will be raised elsewhere.

Rev Dr Ian Paisley: You were not present for the Minister’s speech, Mr Speaker. He made the point that the amendment we put down made it look as if we were watering down our stand. I was simply commenting on how, to my knowledge — to my knowledge — that came about. That is a legitimate point that I need to make.

Mr Speaker: I accept that, and I accept that as far as the Minister is concerned there may have been some misunderstanding about the question of how amendments may be put down. That is not the issue; it is not the matter on which I took issue with the Member.

Mr Kieran McCarthy: On a point of order, Mr Speaker. The Member referred to a meeting of the Business Committee being held last night. I am a member of that Committee, and I can assure the House that there was no meeting of the Business Committee last night.

Mr Speaker: Order. There seems to be some sort of infectious misunderstanding developing. For all that I do not agree with some of the things that Dr Paisley said, I have to say that he did not suggest that there was a meeting of the Business Committee last night.

A Member: Read Hansard tomorrow.

Mr Kieran McCarthy: I beg your pardon?

Mr Speaker: We will all read Hansard with interest tomorrow.

Rev Dr Ian Paisley: I suggest that the hon Member for Strangford should wake up and listen to what I have to say.

Mr Kieran McCarthy: Mr Speaker, I think the Member did say that there was a meeting of the Business Committee last night. He should look over his notes.

Mr Speaker: Order.

Rev Dr Ian Paisley: I do not have any notes. Members know that I speak extemporaneously. I have only a note of the business of the House here.
Having made that point — and made it effectively because of the interruptions — I move to another point. It was said that the DUP should vote for rent increases, and that its not doing so contributed to the non- progression of the warm homes scheme. I will never come to the House and vote in favour of rent increases in order to finance another programme. Many people can ill afford to pay the rent that is set. The warm homes scheme should be financed completely independently of rent-setting.
The Minister should not bring in those sidelines because he is not happy about the amendment. I thought that he would be happy with the amendment. I did not think that he would castigate the DUP and tell us that we had not changed. However, I discover now that he thinks we have changed. Maybe I have successfully disillusioned him.
Nevertheless, the amendment is clear. Someone said that it was trying to mask what it was really attempting to do. The DUP is not masking its intentions. It is clear what we want.

Mr Seamus Close: This is the third Budget to be presented to the Assembly. The Minister says in his foreword that
"The Agreement has provided an opportunity for the people of Northern Ireland to forge their own destiny and seek a new beginning ... we now have locally elected and accountable politicians taking decisions that affect the every-day lives of our people."
Now we know where the buck stops for non-delivery of particular services.
Today the Assembly is being asked to approve the programme of expenditure proposals for 2002-03. It is reasonable to ask whether those proposals will help the people of Northern Ireland to forge their own destiny, and whether they have noticed their lives or destinies being changed since the Assembly became a reality.
Is this the best that the Executive can do, and does it thus warrant the Assembly’s support? The consultative process has undoubtedly improved — not only in respect of statutory Committees but also so far as civil society, with its many interests and lobby groups who are availing of the opportunity to have their concerns input to the process, is concerned.
While consultation has improved and scrutiny is beginning to have some meaning, further improvement can and must be made. However, in the final analysis the outcome of consultation is measured by results. Have the Executive listened to the consultation? In this regard it would be particularly churlish of me not to recognise and acknowledge the changes that have been introduced since the draft Budget: for example, the reinstatement from October 2002 of free nursing care for the elderly and the restoration of the resources grant to local authorities.
However, other areas have been ignored, and we could not let this opportunity pass without referring to the ubiquitous regional rate. The spending proposals for approval this afternoon require the domestic regional rate to be increased by 7% and the non-domestic regional rate by 3·3%. Do any ratepayers, domestic or business, support these measures? I do not think so. I have not seen any evidence of support; on the contrary, I can point to loud and widespread expressions of total opposition to such increases. The people who are opposed to these increases do not believe that they are being allowed to forge their own destiny; rather they see their future being impaired by these inflation-plus increases.
Who are the Executive representing by continuing with their iniquitous increases, particularly given the impact on small businesses and those on fixed incomes, such as senior citizens? We have been promised a review of the rating system, but, like many other aspects of the Programme for Government that we discussed yesterday, the timetable is slipping. Three years have passed, and nothing has happened.
While I welcome the 7·5% increase in total departmental expenditure over 2001-02, it is crucially important that the Assembly examine running costs and question whether efficiencies could or should be made in order to redirect those finite resources to that which ought to be our number one priority, namely health. I have spent some time looking at departmental running costs in 2000-01 and comparing them with the proposals for 2002-03. The picture is not encouraging; it points to potential savings that should have been made.
Running costs for the Department of Agriculture and Rural Development have increased over this period by £8·9 million, or 9·7%. The Department of Culture, Arts and Leisure’s costs have increased by a whopping 37·9%, or £4·4 million. The Department of Education’s costs are up by 16·1%. The cost of running the Department for Employment and Learning has risen by 46·5%, or £12·6 million; the Department of Enterprise, Trade and Investment by 8·8%; the Department of Finance and Personnel by 8·4%; the Department of Health, Social Services and Public Safety by 9·2%; the Department of the Environment by 22·6%; the Department for Regional Development by 8·7%; the Department for Social Development by 28·6%, or £41·2 million. The running costs of the Office of the First Minister and the Deputy First Minister have increased by 30·6%.
Over that period, total departmental running costs have increased by £105·9 million to £733 million, which is an increase of 16·9%. Better control of these running costs could have produced savings in the region of £40 million to £50 million. This must be considered along with the overall review of public expenditure in Northern Ireland. It is yet another area where the Executive have promised much, but delivered little.
We are overgoverned and heavily burdened with administrative and bureaucratic costs. There must be more layers of bureaucracy in Northern Ireland than there are skins on an onion. There are 26 local authorities and a plethora of health trusts, boards and quangos, all eating into our financial resources and reducing our ability to deliver the coalface services that the people demand and need.
If people were asked what difference the Assembly has made to their lives, I am sure that many would point to the welcome degree of stability that has followed in its wake. They would point to economic growth and aspire to a better future with the fulfilment of many outstanding promises.
However, they could also point to gross inequalities and the widening gap between rich and poor. Nowhere is this better demonstrated than in healthcare. The recent publication by the General Consumer Council for Northern Ireland, ‘The Price of Being Poor’, should be compulsory reading for every Minister in the Executive. I have said it before, and I will say it again —

Mr Speaker: Order. I must intervene, because the arrangement, made through the usual channels, is that we will suspend, by leave, and resume at 1.30 pm. I am not bringing the Member’s speech to an end, merely introducing an interlude. He may, if he wishes, and with the permission of the Chair, continue when we resume.
The sitting was suspended at 12.30 pm.
On resuming (Mr Deputy Speaker [Mr McClelland] in the Chair) —

Mr Seamus Close: Before lunch, I pointed out that the Health Service was in crisis. Even with the additional £41 million allocated in the Budget, the professionals say that that is only a drop in the ocean because of years of underfunding under direct rule. Throughout the 1980s and 1990s, the people to whom I refer as the "pinstripe suit brigade" and the "know-alls" savaged the hospitals and healthcare by cutting down on the provision of nurses, auxiliaries, beds and doctors. They enforced so-called efficiency savings year on year to such an extent that the fabric of health was damaged severely.
Idiots effectively decimated the home help service, which did a first-class job and cost relatively little. If we are to make a difference and create a new beginning that the people of Northern Ireland can look forward to, the Health Service must be targeted as a number one priority, even at the expense of other Departments interests; worthy though they may think themselves to be. We must break out of the departmental mentality and deal effectively with real life and death issues. It is fundamentally wrong for the Executive to treat our senior citizens less favourably than those in other parts of the United Kingdom are treated. I have acknowledged the reinstatement of free nursing care for the elderly in the Budget, effective from October 2002. However, the fact that its removal was considered is an indictment on the Executive and a demonstration that their priorities are wide of the mark. The Executive should not fall into the fashionable trap of drawing a false distinction between nursing care and personal care.
In February 2001, the Assembly called on the Executive to implement fully the Royal Commission on Long Term Care for the Elderly and to provide senior citizens with free nursing and personal care. Why has that call also been ignored in the current funding proposals? How can we support proposals that ignore the voice of the Assembly? How can we claim to be targeting social need when we allow that anomaly to exist between nursing care and personal care? The provision of money is not the problem; it is the will to prioritise that money that is lacking. A sum of £25 million to £30 million should and could have been found.
Ageism is wrong, and the Assembly should not tolerate it or act in a discriminatory fashion by using semantics as a form of justification. In following such a course, the Executive prevent our senior citizens from forging their own destiny. Therefore, they are failing a large and growing percentage of the population — a group that we all aspire to reach some day.
It is not just our elderly who are suffering from a pigeonhole mentality, whereby each Department believes that it is entitled to its own percentage increase year on year. Day and daily, new nightmarish tales emerge that demonstrate that the Executive are failing to address the health crisis. The Budget perpetuates that crisis. Patients with brain tumours are being sent home, and at the same time beds are closed temporarily. Almost 57,000 patients are on waiting lists, which is 6,500 more than last year. That figure includes 8,000 people who have waited for more than 12 months. Some of those people suffer from heart conditions. Who would dare to say that that is not a life and death issue? Waiting lists in Northern Ireland are now approximately 50% higher than in England in proportion to our population, yet we pay the same taxes and the same National Insurance contributions. Our priorities are wrong. Visit any —

Mr Donovan McClelland: The Speaker indicated that Members had 10 minutes to speak. Mr Close, I have given you some flexibility because of the lunch break, but I ask you to bring your remarks to a close.

Mr Seamus Close: To the best of my knowledge, the Speaker — and I stand to be corrected — did not indicate any time allocation before the debate commenced. Mr Deputy Speaker, I ask you to demonstrate a little flexibility, concern and fair play —

Mr Donovan McClelland: I shall try to be as flexible as possible, Mr Close. Please continue.

Mr Seamus Close: The parties that have already spoken have Members on the Executive, and some party Members have spoken twice. This is the first opportunity for an opposition party to express its views, so I ask for balance.

Mr Donovan McClelland: I am endeavouring to exercise balance.

Mr Seamus Close: The Budget contains expenditure proposals to contain waiting lists at March 2002 levels. Am I supposed to applaud and support that? Is it not more important to reduce hospital waiting lists than to reduce planning applications? The Executive plan to eliminate the backlog of planning applications by the end of 2002. At the same time, they intend to maintain hospital waiting lists at the March 2002 level. There is something wrong with that.
Although the Health Service is not getting what it needs to deal with the crisis, it must also shoulder its responsibility for spending properly what it receives. We must ask why certain things are happening. Why is it that, given that an extra £8 million was allocated to reduce waiting lists, those lists are up by 6,500 on last year? Why have there been improper payments of millions of pounds in exemptions from prescription charges through the family practitioner service? Why has a car park allegedly been subsidised to the tune of nearly £500,000 per year due to some half-baked PFI scheme?
There are other problem areas. Today, the accounts of the local government auditor were published. Time and again, they demonstrate that there are no proper controls on how our money is spent. That needs to be sorted out, and we should learn from it.
Do we need the many glossy magazines and brochures that are produced by each Department? We consult ourselves to death and spend too much of the taxpayers’ money in the process. Would it not be better if such reports were placed in a public library or some other public building, where they could be made available, on request, to those who are interested in them?
This Budget fails. I have tried to gauge it according to how it deals with the weakest and most vulnerable in society. I concede that it operates within constraints. However, even within those constraints, it fails the weakest and the most vulnerable people.
I thank the outgoing Minister of Finance and Personnel, who is now the Deputy First Minister. We operate under a strange political system, which has a multiparty Executive. Undoubtedly some members of the Executive are playing to different galleries. However, it is the Minister of Finance and Personnel who takes the flak. He has been able to deal with that flak due to his larger- than-life personality. At times, he has even managed to cut the sting from a thorn such as myself, for which I give him credit. I wish him well in his new position, but I feel sorry for his successor.
It would be wrong not to mention the amendment tabled by the Democratic Unionist Party. Fuel poverty concerns and taxes us all. However, I envy the Democratic Unionist Party. It has two seats on the Executive, from where its Ministers could have argued that justifiable case. I do not have a seat; I wish to goodness that I did. One must question whether there is a political motive behind the amendment. Will I support it? No. My vote in this important debate treats me as some sort of "lesser-spotted democrat". I do not even have a vote that counts. Therefore, I shall not support the amendment, and I certainly shall not support the Budget.

Mr Donovan McClelland: It is difficult to manage the debate. The Business Committee has allocated it three hours, and many Members have indicated that they wish to speak. If I am to include everyone, I must limit subsequent Members’ contributions to six minutes.

Mr Robert McCartney: On a point of order, Mr Deputy Speaker. The Members of the House and the public are becoming increasingly aware that the most important and serious matters, such as this debate, are being limited in a draconian manner. For a House that sits on only two days a week, one must question why only three hours were allocated for the debate.

Prof Monica McWilliams: Further to that point of order, Mr Deputy Speaker. It has been the custom of the House that each party has the right to speak for at least 10 minutes in a Budget debate. As Mr Close said, we consider our parties to be the Opposition. Our Members will be restricted to six minutes, although other parties made at least two or three speeches before the ruling was made.

Mr Donovan McClelland: I remind both Ms McWilliams and Mr McCartney that that was not my decision. It was taken by the Business Committee, on which you sit, Ms McWilliams, and on which you have the right to sit, Mr McCartney. There is a time limit of three hours for the debate. I am willing to allow Members from smaller parties to speak for much longer, but that will limit the number of Members who are able to speak.

Mr Robert McCartney: Essentially, the larger parties control the Business Committee. It speaks volumes that not a single Member of the largest party in the Assembly, the Ulster Unionist Party, is in the House. The SDLP has only the Minister and one other Member present.

Mr Donovan McClelland: That is not a point of order. Valuable time is being wasted.

Prof Monica McWilliams: As a member of the Business Committee, I assure you that the Committee did not decide to limit the time allocated to each Member to six minutes. Indeed, my clock tells me —

Mr Donovan McClelland: I did not say that the Business Committee allocated only six minutes to each Member; I said that the Business Committee limited the debate to three hours. You may check that in Hansard. If all those Members who put their names forward are to be allowed to speak, there must be a limit on the time allowed to each Member. I shall not waste any more time.

Mr Boyd Douglas: I wish to comment on some of the Executive’s priorities, and to reflect on those issues that were deemed to be unimportant. I welcome the generosity of the Chancellor of the Exchequer, whose intervention to the tune of £9 million has secured free nursing care for the elderly. That measure should bring neither praise nor thanks to the Executive, from whose Members it received no support. They did not consider it worthy of inclusion in the original draft Budget. Instead they chose to support other elements that, in my opinion and that of many others, pale into insignificance when compared to healthcare and the well-being of our senior citizens.
One example that has already been mentioned is found in the Department of Culture, Arts and Leisure’s budget. The North/South Language Body has been allocated £3·8 million. Would the electorate of Northern Ireland consider that body to be more valuable than elderly people? I suggest not.
I thank Mr Brown for giving the Assembly an injection of cash, common sense, and common values. However, despite our gratitude, free nursing care is not the end of the story. We must not ignore personal care. Members will be aware that all senior citizens in Scotland will have their care needs met, regardless of whether they live in their own homes or in nursing homes. That care is vital. It can often be the difference between life and death. The Executive must address that issue.
There can be no justice when people work all their lives and save for their retirement, only to be punished in their senior years for being careful with their money. Nobody should be forced to sell his or her home and property in order to pay for care. The only expense that the elderly should incur should be the cost of living. Resources must be found. The elderly in Northern Ireland should not be disadvantaged. They must not become the poor relations of the British Isles because of variations in devolved power.
I am glad to hear the various ideas that the Executive are investigating to address the infrastructure deficits in the Province. Although I am not an avid supporter of private finance initiatives and public-private partnerships in their barest form, there is a need to find ways to enhance and improve our infrastructure. It would not be possible to do so out of public receipts without increasing the taxation burden on people in Northern Ireland.
It is good news that the review will be completed by March 2002 and actioned during the course of the year in those areas that are deemed suitable. I welcome the completion of the rating policy review by October 2002. However, I wish that a structure movement was indicated in the review of local government. That would be a way to save money, which could be re-allocated for more useful purposes. Northern Ireland must have the most top-heavy public administration in the British Isles, with 26 local councils and 108 Assembly Members for a population of 1·6 million.
A swift rationalisation of local government, as well as health boards and trusts, education and library boards and numerous other quangos, would surely reduce duplication of workloads, bureaucracy and red tape. That would release more resources for front-line services — where they belong — instead of using them to pay for increasing volumes of paper that are pushed from pillar to post and never properly dealt with.
There are many admirable and achievable aspirations in the Budget. However, I caution against window dressing, which can obscure the real needs that should be met. As a society, we must look after those who are most vulnerable and identify areas that hold that aspiration to ransom. Finances can be cut and savings can be made. That money can be allocated where it is most needed from the outset and not fed in later by the Chancellor, whose aims are often different from our own.

Prof Monica McWilliams: I take this opportunity to pay tribute to the Minister of Finance and Personnel, Mr Durkan, on what is probably his last Budget. That said, I am concerned about the number of times that funding allocations are presented to the House. I am glad that the Minister said that there must be another way to consider allocations.
The Business Committee decided at a meeting earlier this afternoon that the December monitoring round will be debated at the first sitting after Christmas. The Budget is being debated today, and the Assembly recently considered the September monitoring round. If one adds end-year flexibility and the Executive programme funds, it leads to a great deal of confusion. It would be useful, alongside the forthcoming needs and effectiveness evaluation of the Departments, if Committees could have an alternative opportunity to consider the demands of the Departments in their entirety. The present method is bitty.
I am also concerned that the Minister felt the need to withhold £125 million for allocation by the Executive next September. A much clearer justification for that is needed, rather than the one-line explanation that was given. That is a substantial sum of money to withhold when we are in such a crisis.
I thank the Minister for noting the sum that will be allocated the following year, but Members must be made aware of exactly how much is being withheld. When the Assembly looks at next year’s allocations, it will know the minimum allocations that will be given to Departments. Nonetheless, until we have a clear understanding of all the sums of money that are being held back, we shall be unable to effectively scrutinise departmental allocations.
Despite the extra money that the Minister has given to health and education, the concern from the community is such that I cannot, as an Assembly Member, justify the fact that £125 million is being withheld.
The details for funding allocated to the Office of the First Minister and the Deputy First Minister are still only single-line explanations. I have raised that issue in every Budget debate. There is still an insufficient breakdown for the units in that Office. Indeed, we are told that an extra £0·8 million will be set aside for the creation of a victims’ fund. It would be useful to see the breakdown of the various functions of the Office of the First Minister and the Deputy First Minister. If there is to be an allocation for victims, a line explaining that would also be useful.
I am concerned — although it may be an administrative error — that £1·5 million has been set aside in the Executive programme funds for a victims’ strategy. That is detailed on page 83 of the Budget. Again, in the next round, £1·5 million is being set aside for a victims’ strategy between 2002 and 2004. Does that mean that a total of £3 million from Executive programme funds is to go to a victims’ strategy, or is that simply an administrative error? I am concerned that a strategy to deal with victims may receive £3 million, when only £0·8 million is allocated from the victims’ fund. That means more bureaucracy and less money for those on the ground.
We deserve a breakdown of the suggested increase of 7·2% for equality, human rights and community relations work. How much will go to the Equality Commission? How much will go to human rights groups and how much to community relations groups?
Health is one of the major concerns. It is clear that health administration eats up a great deal of the funding; that problem must be addressed. Salaries take up more funding than service development. Some 40% of the block grant goes to health, but we have no assurance that that level of funding will continue, despite the increases. Estimates have indicated that the real figure represented by 40% of the block grant will go down rather than up.
It was good to hear that the Programme for Government included reference to 1,000 care packages. However, is it guaranteed that that money has been set aside, or will it have to be found elsewhere? There is still concern that free nursing care will be introduced only in October 2002; it could have been introduced in April. That it will not be is not entirely the fault of the Minister; I lay responsibility for that at the door of the Department of Health, Social Services and Public Safety, which has failed to pass the legislation to allow that funding to be freed up. That legislation has not yet reached Committee Stage. Had the Minister decided to introduce free nursing care next April, he might have been unable to do so because the legislation would not have been in place. The Department and the Executive must get their act together and ensure that Bills that affect financial resources are put before the Assembly in time.
Later today, we shall debate waiting lists and cutbacks in the Health Service. Many of us visited hospitals in the past year. I never thought that I would see such sights in a hospital run by the National Health Service. One patient, in a bed, was paying for his own drugs. Another patient, also in a bed, was waiting for his arthritis drug. A third, in the next bed, was already being given the drug. Imagine how the second patient must have felt.
Mr Deputy Speaker, I hope that you do not intend to restrict me to six minutes —

Mr Donovan McClelland: I ask the Member to draw her remarks to a close.

Prof Monica McWilliams: I shall take the matter up with the Speaker. It has never before been the case in the House that leaders or members of parties whose representatives have not spoken are suddenly restricted to six minutes when other Members have been given in excess of 10 minutes. I shall do as you say and bring my remarks to a close.
I am concerned that we have before us only the first round allocations of Executive programme funds, not the second round. I am aware that £69·8 million is still outstanding in the infrastructure fund. I had hoped that the Minister would tell us today that an allocation was being made from that fund for the cancer hospital on the Belfast City Hospital site. Again, I cannot explain to people why such large sums remain in the programme funds, when urgent decisions about cancer hospitals are outstanding.

Mr Robert McCartney: I congratulate Ms McWilliams and Mr Close on their clear analysis of what has been going on. This is the Christmas season. It is the season of great expectations, of lists to Santa Claus. It is also a season of great reality, when many children realise that Santa Claus cannot deliver their wish list. The Programme for Government is a wish list; in cold, cruel reality there is little prospect of its grand aspirations being delivered.
The reason for that is the absence of adequate resources. The fault in the inadequacy of the resources is the terms on which the major parties, distinguished only by the paucity of their appearance here today, created the Assembly. One was so anxious to have a devolved Administration that it could claim was protecting the Union, and the other was so anxious to have a Nationalist agenda of institutions that were a transitional mode to a united Ireland that both failed to negotiate properly with central Government for sufficient resources to do the job. Now, of course, they find themselves in the position of having insufficient money to fulfil the bargain into which they entered.
It is a matter of common knowledge among economists that at the date of devolution there was a deficit of approximately £6 billion in infrastructure investment due to underinvestment during direct rule. There is absolutely no prospect, under the Barnett formula, that the devolved Government will find enough money to make good the deficiencies in our infrastructure, let alone have sufficient funds to run the day-to-day administration of the Province.
Mr Close mentioned the cost of administration. More than 10% of the block grant — £730 million — is allocated to the administration of government, and that share is increasing. Why is that? It is for political reasons, not for reasons of efficiency or economy. We have 10 Departments when six would have sufficed. There are about 160 quangos that spend more money and cost more money to run than the 26 local government authorities.
What do we have? We have a Health Service that is a disgrace in a modern Western democracy. We have waiting lists that are 50% greater than in the rest of the United Kingdom, where waiting lists are already a matter of acute criticism. What has the Minister of Finance and Personnel done? Essentially, he has abandoned the fundamental principle that Northern Ireland should have parity of treatment, which even under the old Stormont Government and Prime Minister Andrews was considered a cornerstone of Northern Ireland’s being part of the United Kingdom.
Why did the Minister do that? He did it because, under the new deal of devolved Government that was supposed to deliver more efficient, accountable and sensitive government, we have a burgeoning bureaucracy. It is the most overgoverned, overpaid bureaucracy in Western Europe. There are 108 Assembly Members, 47 of whom receive additional payment, and the Senior Salaries Review Body (SSRB) is considering whether they should be paid even more. That money should be devoted to the people who really need it.
It has been rightly said that a society is judged by how it treats its most vulnerable members — the very old and the very young. Certainly it is reflected in the care of the very old. The vast majority of those people paid National Insurance contributions to ensure that they would be protected and looked after in their old age. That is not the case. However, the grasshoppers who never worked and who never wanted to work, but who indulged themselves at the expense of those who did, and who saved nothing, got nothing and preserved nothing, get free care. Those people who worked like ants all their lives, who paid their income tax and National Insurance contributions, and who took out mortgages so that they could live in their own homes and not be a burden on the state, are screwed by what amounts to robbery by the state.
Those people are robbed of their savings. This Budget does absolutely nothing for them. It does not take a page out of the book of its Scottish counterpart.
The aged are often also the sick, the people who need elective surgery. Elective surgery is not available as a priority in Northern Ireland. The Musgrave Park Hospital, the Royal Hospitals and the Ulster Hospital have all suspended elective surgery for lengthy periods. Strokes and heart conditions are also the products of old age, and people who suffer from them are not looked after properly. I recently heard of the case of a man who was told by his cardiologist that he should have a bypass operation within seven days, or 10 days at most. The man was a member of the British United Provident Association (BUPA). The earliest that the operation could be done in Northern Ireland was in three months’ time. If the man had been an NHS patient, he would have had to wait two years. That is an indictment of what the Executive provide.
There is competition between the various portfolios because the Ministers are not a cabinet — they cannot prioritise anything. Each Minister is a warlord over his own portfolio, and all the Ministers compete against one another. May I say that —

Mr Donovan McClelland: Mr McCartney, please bring your remarks to a close.

Mr Robert McCartney: Mr Deputy Speaker, the leader of the Alliance Party was rightly given 13·5 minutes; that was the level of flexibility that you showed towards him. I endorse what Ms McWilliams said. As one of the few Members of the Opposition in the House, I cannot see why I should be hampered from having a proper opportunity to speak. It is a disgrace to democracy, and it is a disgrace on the part of the Business Committee.

Mr Donovan McClelland: Mr McCartney, your time is up.

Mr Fred Cobain: I sympathise with Members who have points to make about what is probably the most important debate of the year.
At last month’s debate on the draft Budget, I spoke on behalf of the Committee for Social Development. I said that the Committee’s programmes and spending priorities were the most marginalised. Yesterday, I spoke again on behalf of the Committee for Social Development in the debate on the Programme for Government. I repeated the message that the Department for Social Development has a weighty responsibility to serve those who are most vulnerable. It is a responsibility that must not be ignored or sidelined, and it must certainly not be regarded as secondary. It is no less important than the responsibility that we rightly accept to offer a decent standard of healthcare. Several Members have already spoken about that issue.
When the Minister of Finance and Personnel published his revised spending plans on Monday 3 December, I asked him if he would confirm whether he recognised that the Department for Social Development dealt with the most marginalised people in society. I also asked him to explain why the Department for Social Development’s budget was the only one that had been reduced since the draft proposals were first published in September. I sought confirmation that the urban regeneration and community development element of the budget had been reduced. I was disappointed with the Minister’s answer, and I wrote to tell him so. I also copied the letter to the Minister for Social Development and asked for his observations.
I apologise for my absence earlier today when the Minister of Finance and Personnel elaborated on the technical adjustments to the Department for Social Development’s budget. There was an irony in my being absent this morning. I was in my constituency to hear an announcement about an investment in housing in North Belfast. I marvel at the way in which Ministers are able to recycle that news story regularly. The public receives the impression that an unlimited amount of money is available, and that Ministers are doing wonderful things.
I am grateful to the Minister of Finance and Personnel for acknowledging the points that I made last week. I will read Hansard with interest, but I am sure that he will understand that I insist on written replies from him and his ministerial Colleagues. I want to pay tribute to the Minister for his efforts to respond directly to questions that were raised in the Budget debate. If he finds that he is unable to do so, perhaps he or his successor could review the Official Report of the debate and give a commitment to providing prompt and full written answers to the points that are raised. Most of the figures that I will quote are taken from page 53 of the December 2001 version of the Northern Ireland Executive Budget 2002-03.
Much has been made of the fact that the Department for Social Development’s budget will increase by 7·5%, compared to this year. If we scratch the surface, we will find that the Department has three stated objectives in the Programme for Government. Our task is to agree the levels of public spending that are needed to meet those objectives.
The first objective relates to the services provided by the Social Security Agency and the Child Support Agency. The effective and efficient administration of benefits is extremely important to many of my constituents and those of other Members. Sadly, benefits continue to be the main source of income for far too many people in Northern Ireland. The cost of administering those benefits is expected to amount to £204 million next year. Of that amount, £195 million is destined for the Social Security Agency. That is a 20% increase on this year’s allocation. Interestingly, the Child Support Agency’s budget will be £1·5 million less than this year’s; that is a reduction of 22%. The Committee has been led to understand that the agencies were implementing efficiency measures that would also lead to improved levels of service.
The Committee is concerned that the administration of the benefits system should run smoothly and that those entitled to benefits should receive the correct level of financial support — at the right time. The Committee accepts that some short-term investments were required to deliver those efficiency savings. However, the bottom line is that the cost of benefit administration next year will increase by 17·5% compared to this year’s spending. The Committee has urged the Minister and the Department for Social Development to ensure that that increase will lead to efficiency savings. The Committee intends to monitor the situation carefully and will insist on more regular and detailed reports about progress on efficiency savings, improvements in the level of service and reduction in fraudulent claims.
The increase for running costs is highly disproportionate in comparison with the Department’s other spending plans.

Mr Donovan McClelland: The Member should draw his remarks to a close.

Mr Fred Cobain: I have several other issues that — [Interruption].

Mr Joe Byrne: On a point of order, Mr Deputy Speaker. Is it possible to extend the time for the debate to 4 pm, given that the original schedule indicated that the debate on the crisis in the Health Service would start at 4 pm?

Mr Ian Paisley Jnr: On a point of order, Mr Deputy Speaker. Would it not be best to suspend Standing Orders until the debate has taken place properly?

Mr Donovan McClelland: I have taken advice on the matter, and I understand that Standing Orders cannot be suspended at this stage. Like Stephen Hawking, I have difficulty bending time. The Business Committee has allocated three hours for the debate. That is the Business Committee’s decision, not the Speaker’s. All that I can do is try to ensure that every Member who wishes to speak gets the opportunity to do so, and that sufficient time is given to the proposer of the amendment and to the Minister for his response. The debate must be carried out within the time allocated by the Business Committee. Perhaps this is a matter to which the Business Committee may wish to apply itself. I will take another point of order, but I am concerned that we are eating into valuable time.

Mr Derek Hussey: I am not attempting to overrule you, Mr Deputy Speaker, but surely the Assembly is the ruling body. I understood that it would be possible to extend the time, with the permission of the Assembly.

Mr Donovan McClelland: I have taken advice on the matter, and I believe that that is not possible.

Mr Joe Byrne: I congratulate the Minister of Finance and Personnel on his third Budget, and on the extensive consultation process conducted by the Executive, both in the House and with organisations and individuals.
First, I welcome the revised Budget proposals, which take account of the Chancellor’s pre-Budget statement and the decision by the Executive to provide an extra £41 million for health and social services. The General Consumer Council’s recent report on poor health outlines the extent of the relationship between poverty and poor health in the North, and the effect that that is having on the life expectancy of those who are less well off. The report underlines the fact that health, economic development and education are closely linked issues that require a co-ordinated approach from an Executive working on a collective basis.
Many patients, and people who work in the Health Service, greatly appreciate the recently increased allocations. However, it is important that patients, rather than administrative needs, benefit most from those budget increases.
Overall, I welcome the 14·8% increase in the budget of the Department for Regional Development, and the planned expenditure of £538·3 million on roads, transport, water and sewerage infrastructure. I am pleased that the maintenance and upgrading of the region’s roads is a departmental priority, and I particularly welcome the allocation of £48 million for the purchase of new rolling stock.
As I stated in yesterday’s debate on the Programme for Government, the new regional transportation strategy must mark a radical departure from what we have experienced in Northern Ireland to date. The Committee for Regional Development has highlighted the importance of investment in our physical infrastructure in order to promote and sustain economic development across Northern Ireland. The Executive’s plans to increase spending on our transport facilities are therefore very welcome. I believe that it is necessary to pursue private finance, by one method or another, to get the necessary funds to invest in capital spending projects. All possible options should be objectively pursued. Value for money criteria should be a key priority in evaluating such proposals.
The Chancellor’s announcement in the pre-Budget statement, signalling the delay of the introduction of the aggregates levy on processed products subject to EU state aid approval, is a welcome one. As the Budget states, it will create additional spending power for the Department for Regional Development. Despite the fact that taxation is a reserved matter, it demonstrates the influence that we can have as Members of the House. It is an acknowledgement of the Assembly’s concerns, expressed last December when it passed a motion from Mr Hussey and myself to reject the introduction of the aggregates levy in Northern Ireland. However, the proposed exemption is only a short-term measure, and it falls short of what the quarry industry in Northern Ireland wanted. I am sure that the quarry industry and Members of the House look forward to the publication later today of the report by the Select Committee on Northern Ireland Affairs on the aggregates levy.
On Employment and Learning, I particularly welcome the additional £37·3 million allocated to expand the number of further and higher education places, and to improve access to student support. It is vital to the economic health of this region that we place such emphasis on further and higher education. Although November’s labour market bulletin states that the number of graduates of working age has more than doubled — from 60,000 in 1990 to 123,000 in 2000 — that figure, which represents 12·1% of the working population, is still below the UK average of 14·5%. Therefore, the measures in the Budget to expand access to higher and further education demonstrate the importance which the Executive attach to the issue.
The improvement of the skills level of the workforce is critical in sustaining economic development. Although expenditure on the employment programme will be reduced by £10·3 million, the Department must remain focused on promoting lifelong learning and helping the long-term unemployed back into work through appropriate and adequate training schemes. The findings of the international adult literacy survey are in November’s ‘Labour Market Bulletin’. It is stated that poor levels of basic skills pose a significant problem for the Northern Ireland economy. It is therefore vital that the Department place greater emphasis on addressing that weakness in the immediate future, and ensure that the New Deal is delivered effectively and directly to those most in need.
It is also vital that areas such as research and development, which in the past have been underfunded, are properly resourced in the future. It is important that our two universities be given every encouragement and assistance to increase their research capability. Research students also deserve greater consideration to enable them to pursue relevant and value-added projects.
I particularly welcome the allocation supplement of £2 million to the Department of the Environment for local council spending, which was announced last week. This is particularly good news for the smaller and poorer councils who face above-average increases in district rates in order to maintain scheduled spending plans.
I welcome the commitment in the Budget to ensure that New TSN, together with the statutory equality legislation, will inform spending decisions in all 11 Departments. I also welcome the intention to subject all spending programmes to ongoing scrutiny.
The Budget provides a route map for our regional economy to become more productive through increased investment in infrastructure, vocational education and training, which will improve the skills base of our workforce. It also demonstrates social conscience and quality- of-life initiatives, as shown by the increased spending on healthcare services and community care. I support the motion.

Mr Sammy Wilson: I support the amendment. The warm homes scheme has been mentioned in the Assembly on 12 occasions during the past year. Members felt that one of the priorities in the Programme for Government and the Budget should be that people should have adequate heating in their homes, which would help alleviate the health and social problems that many people, particularly in old homes, face as a result of the cold.
There have been many arguments against the amendment. The Minister of Finance and Personnel said that it was only an attempt by the DUP to exploit those who suffer from fuel poverty. However, as I have just pointed out, Members across the House have repeatedly raised the issue. In fact it is a pity that Mr Cobain has left, because at the last Social Development Committee meeting he said that he was in favour of an amendment to allocate more money in order to alleviate fuel poverty.
Only last week, a member of Mr Durkan’s own party raised the issue with the Minister for Social Development, indicating that 600 people could die this winter. Not only did he want money to be spent on improved heating systems, he actually asked the Minister to consider ways in which to provide help with fuel bills.
Mr McClarty of the Ulster Unionist Party said that fuel poverty is one of Northern Ireland’s hidden disgraces. Mr Ford even wanted to impose a levy on electricity consumers. Mr O’Connor of the SDLP described that as a stealth tax, but he said that it was important to do it in order to deal with the problem. We are not exploiting an issue; we are simply responding to Members.
Mr Seamus Close is so predictable. He showed his arrogance when he told us that this is the DUP at it again, and that they should have gone to the Executive and fought their case. He was talking as though money for Departments was a kind of attendance allowance handed out for Ministers going to Executive meetings. If that is the case, then Bairbre de Brún must have been living with the Minister of Finance and Personnel; she has had an increase of 33% over the last two years. However, if one takes that argument to its logical conclusion, then why has the Department of Enterprise, Trade and Investment received a cut?

Mr Seamus Close: Will the Member give way?

Mr Sammy Wilson: No, I do not have time to give way because I will be cut down in a moment or two.
If attendance at Executive meetings were the criterion for getting funding, then why have the frequent attenders not received the money that they asked for?
Another argument is that we would be cutting money from essential services — the cross-border bodies. Let us look at the spending of some of these cross-border bodies. InterTradeIreland plans to gather statistics on cross-border trade. They will use money to do work through existing Departments and to duplicate the work currently being undertaken by the Industrial Development Board and LEDU.
The Food Safety Promotion Board is going to use its money to increase the bureaucracy that Mr McCartney talked about. There are to be 20 more staff. I have a lovely quotation on the essential services that Mr Durkan was talking about. The last time it was discussed, Dr McDonnell said
"I just wonder if at some stage we could get down to practical matters that would make a difference to ordinary people’s lives." — [Official Report, Bound Volume 13, p.205]
As far as he was concerned, the Food Safety Promotion Board was not then making a difference to people’s lives.
Mr Durkan mentioned Waterways Ireland. What is it using its money for? The last time we had a discussion on it in the Assembly, there were three consultation exercises. There were to be consultants to look at a corporate image. I am sure that that takes great priority over putting heat into someone’s house to stop them from dying. The body was going to look at new premises. It had underspent, yet Mr Durkan says that money is needed for this body to deliver essential services.
The Foyle, Carlingford and Irish Lights Commission is also fond of consultation. Consultants have been employed on recruiting members to the forum, on their staffing structure and on their equality scheme. The commission is tagging salmon carcasses. The Minister has told us that she does not know if it has been effective or not. It is so busy —

Mr Donovan McClelland: Mr Wilson, please draw your remarks to a conclusion.

Mr Sammy Wilson: I will.
It is so busy that it has not even been able to turn in its annual report yet. These are the essential bodies that Mr Durkan has been telling us about. There are many quotations on the ineffectiveness of these bodies, yet we are told that we must give this money to them. It is more important that these bodies be sustained than that people have warmth provided in their homes. I think that —

Mr Donovan McClelland: Sorry, but your time is up.

Mr Sammy Wilson: Anyone listening to this objectively will support the DUP amendment and will support warm homes for people who are living in fuel poverty.

Mr Derek Hussey: I want to comment on section 7 of the Budget.
I apologise for this delay — you have caught me on the hop.

Mr Danny Kennedy: It is not often that the Member is caught on the hop — [Interruption].

Mr Derek Hussey: Somebody else has been caught on the hop.

Mr Danny Kennedy: Time is going on.

Mr Derek Hussey: My remarks will be brief. I am concerned about the reduction of the indicative allocations, set in December 2000, for each Department for 2003-04 by around £125 million, to be known as the Executive SR 2002 allocation. The Minister talked about this last week, saying that the Executive would reduce indicative baselines for that year by £125 million through the allocation of indicative minima to Departments.
I have a few questions for the Minister. When will Departments be informed of the indicative figures? How will this affect their departmental plans to work toward efficiency targets? Will this reduction encourage Departments simply to bid again for activities previously dropped to achieve efficiency savings, rather than to target limited resources on new activities? Is there a danger that the transparency of the Budget process will be lost if resources are creamed off to meet unspecified needs?
Will the Minister give us some indication of these needs? Will he also tell us how the rationale for withholding £125 million differs from the approach in the Executive programme funds, and what criteria will be set to determine how resources are allocated to Departments? The Minister is aware of concerns that Executive programme funds are sometimes regarded as something that should have originally been allocated to Departments. I have already put this point to the Minister. I am concerned that the reduction of £125 million in indicative baselines is creating a similar scenario to that of the Executive programme funds.

Mr Danny O'Connor: I support the Budget. It is a fair and professional attempt to meet the comprehensive needs of our society. This is a difficult task, given the complexity of trying to meet the needs of every Department, which cannot be achieved by offering so-called simple solutions.
Sammy Wilson said that doing away with North/South bodies would save about £1·3 million. I agree with his passion for creating warm homes. However, this cannot be an either/or situation. The Department for Social Development will have £6·8 million extra for housing associations, but there will be £0·5 million less for the Housing Executive, and there will also be a £5 million reduction in money for urban regeneration and community development. However, the Minister seems to need an extra 20% — £35 million — for social security administration. Mr Wilson has not mentioned cutting down the social security administration budget and using that money to provide warm homes for people. These figures are set out on page 53 of the 2002-03 Budget.
The needs of our Health Service are paramount. I had the misfortune to be in hospital recently. Staff are being run off their feet, and cubicles are being shared in casualty departments. Money must be invested. Bob McCartney was right when he said that there was a historical underinvestment of £6 billion. We must redress that situation.
Since devolution, an extra £687 million has been put into the Health Service — an increase of 37%. The Assembly should be proud of the financial astuteness and prudence of the Minister of Finance and Personnel in being able to deliver the introduction of free nursing care. We all care about people, and the delivery of free nursing care to the people of Northern Ireland has been a big plus for the Assembly. I congratulate the Minister on achieving that.
Mr McCartney was right when he said that the Barnett formula is unfair. However, he did not address one single issue in the Budget. I want to see the historical underfunding being addressed. We were promised a peace dividend. However, the money that does not now have to be spent on security and security installations, and the mechanics of a war machine, has been taken away from the people of Northern Ireland. We should be having our peace dividend now that that money is not being spent on security apparatus.
It is about time that we pressed the Government for an increase in the block grant.
I wish to talk about health and care in the community. There are 19 trusts and four health boards, which poses a problem. A sum of £1 million was paid out last year to non-executive directors in the Health Service here alone. That is almost equivalent to the amounts included in Mr Morrow’s amendment. I am all for reducing the quangos. We and the councils must be accountable, so let us do away with boards that seem to gobble up endless amounts of money.

Mr Sammy Wilson: Do away with the cross-border bodies.

Mr Danny O'Connor: It is all right for Mr Wilson to chirp from the sidelines about cross-border quangos, as he calls them, but they were voted for by 71·12% of the people as an essential part of the Good Friday Agreement. Whether Mr Wilson likes it or not, they are here to stay.
With regard to reducing expenditure on bureaucracy in the Health Service, I wish to address parallel imports, which allow pharmacists to claim a maximum amount of money for prescription drugs, only to bring them in from abroad. That takes away vital resources from patient care.

Mr Donovan McClelland: Please draw your comments to a close, Mr O’Connor.

Mr Danny O'Connor: I support the Budget and reject the amendment.

Mr Mervyn Carrick: I welcome the opportunity to contribute to the debate. I reiterate the comments made by my Colleague Mr Morrow, who identified the vulnerable section of the community that suffers from fuel poverty. I want to focus on another vulnerable group — people who need basic adult education.
In today’s meeting of the Committee for Employment and Learning, Prof Loreto Todd quoted from an article in the 19 November 2001 edition of the ‘Irish Independent’, which stated that
"More than half a million adults cannot access healthcare services properly because of inadequate literacy skills".
That is a terrible indictment of a system that seems to have failed a sizeable section of the population surveyed. Indeed, the findings of the international adult literacy survey (IALS), in which Northern Ireland was benchmarked against almost all the Organisation for Economic Co-operation and Development (OECD) countries, indicate that 24% of the adult population of Northern Ireland performs at the lowest levels of literacy. That is equal to some 260,000 people and compares poorly with our economic competitors such as Belgium at 18%, Germany at 14%, the Netherlands at 11% and Sweden at 8%.
Members from all parties have highlighted the subject of basic skills on numerous occasions in the House. Rarely does a meeting of the Committee for Employment and Learning, of which I am the Deputy Chairperson, go by without reference to the problem of literacy and numeracy. It is good to hear Mr Byrne and Mr Dallat on the SDLP Benches continually raising the subject. If the amendment originally tabled in my name had been deemed competent, I would have expected Mr Byrne and Mr Dallat to support it. They will not have the opportunity to do that now. Perhaps they will consider supporting the warmer homes amendment.
There is a flaw in the Budget in that there seems to be a lack of co-ordination on basic adult education between it and the Programme for Government. The Programme for Government states that the Executive are
"committed to taking action to tackle these problems."
If the problem has forced its way into the Programme for Government, one would expect to be able to identify the accompanying and appropriate funding to tackle it. However, so far as I can ascertain, the Department for Employment and Learning’s public service agreement does not give any prominence to the problem. Furthermore, the service delivery agreement appears to be silent on the issue. With unemployment falling in recent years, the cohort of 260,000 adults who lack basic literacy and numeracy skills have become an important entity in the socio-economic agenda in Northern Ireland.
The Department for Employment and Learning presented a business case for a financial resource requirement of some £13 million for the three years commencing 2001-02. In the current year, there was a shortfall of £2 million because the Department was unsuccessful in its bid for Executive programme funds. In 2002-03, there will be a shortfall of £2·2 million because there was a shortfall in the Executive programme funds requirement. Having applied for £3·4 million, the Department succeeded in getting only £1·2 million. An application for £3·5 million from the Executive programme funds was made for 2003-04, but only £1·2 million was allocated — a shortfall of £2·3 million.
It is time for the lip service to cease; it is time for action. More than 250,000 adults are vulnerable due to their lack of literacy and numeracy skills. There must be funding to accompany the fine words in the Programme for Government. Otherwise, it is simply a lot of talk and window dressing. As I said before, there must be action now.
The Minister of Finance and Personnel reminded the House this morning that the Executive listen and respond. How many times do Members have to remind the Executive and the Minister that funding is needed for that critical section of our population? It is vital that the money come now — not in 2003 or further down the line.

Mr Maurice Morrow: I know that you are pushing hard on time, Mr Deputy Speaker, and I shall try to accommodate you. I have listened carefully to Members’ remarks, and it is ironic that none of them has said that the idea of providing more resources for a warm homes scheme is not a good idea. Even those Members who have said that they will not support the amendment acknowledge the need to tackle fuel poverty in Northern Ireland.
I have listened to one or two Members who are somewhat sceptical, but perhaps that is to be expected from those who have no real reason to vote against the amendment. I was particularly concerned to hear Mr ONeill question why both rich and poor receive the £200 fuel payment. That is how it is. I suspect that he has not thought the whole matter through. I thought that he would know that the fuel payment of £200 is a parity issue. Some Members who spoke today seemed to be confused about that.
Social security was also mentioned. Members know that, while it is administered in Northern Ireland, social security is a parity issue. Mr O’Connor was also critical of the administration of social security. However, the Department for Employment and Learning will roll out one service across the Province. Members of the Committee for Social Development were invited to visit the pilot scheme in Dungannon. Mr O’Connor may have attended that. I have heard no criticism from people who have visited the scheme and have seen it up and running. Therefore, all those who say that they are concerned about fuel poverty now have an option and an opportunity to put their vote where their mouth is. It is one thing to talk about the issue, but another to deliver on it.
Perhaps Mr Close will change his mind before the day is out, but I am disappointed that he cannot find it in his heart to support the amendment. He has also said that he will not support the Budget, so at least he is neutral. Perhaps that is the position he always wants — neutral, whatever the issue. However, Mr Close should get off the fence and join the rest of us.

Mr Seamus Close: Does the Member not accept that under this perverse voting system, on what should be the most important date in the Assembly’s calendar, people such as me, who are described as "Other", do not have a vote that counts? My electorate is disenfranchised — I cannot vote on its behalf.

Mr Maurice Morrow: That point is worth arguing. However, did Mr Close not sign up to this? Did he not help to bring all this about? Was his party not party to the whole thing? Surely he cannot sit here now and grouse. He should be re-designate and support us, because re-designation will be nothing new for the Alliance Party. It has jumped through that hoop before, and it will jump through it again.
A relatively small sum of money is being requested. There should be no problem obtaining that funding from the different resources that have been highlighted. It would not impact significantly on the workings of those quangos, and it would better many people in Northern Ireland’s lot. I urge everyone who sits in the valley of indecision to step out with us and vote to improve the lot of the elderly and the fuel poor in Northern Ireland.

Mr Mark Durkan: This has been a helpful debate that has raised and explored several issues. However, I share with many Members the regret about the time constraints that have been imposed. Members have not been allowed to discuss fully the range of issues in the Budget, and many Members have been unable to participate in the debate. Some Members have insinuated that the time limit was sought either on my behalf or on the Executive’s behalf. I remind Members that I have sat in the House faithfully through long Budget debates and — believe it or not — have been happy to do so.
I am available when statements are being made on financial allocations. Ms McWilliams said that there may be too many statements on allocations, but for each statement I have also been available for an hour of questions. I have not attempted to evade or curb debate on the Budget.
Maturity and realism have been evident across the Chamber as Members addressed different issues. That is good to see and it shows that we are maturing as an Assembly. We have a firmer grip on understanding our responsibilities and understanding the limitations of resources. We are beginning to understand that we must develop better ways to meet the needs of the services about which we all care.
I have heard nothing from Members who spoke in favour of the amendment that would change my view that it is a cynical attempt to injure the agreement by manipulating an important and emotive issue. I understand that that is classic opposition politics, and the agreement allows for that. It is just a pity that the DUP will not do more of what the agreement allows for and play its full part in decision-making by attending Executive meetings. There, their Ministers could contribute their views, not only on their departmental responsibilities but on all matters relating to government. In that regard, I appreciate Mr Carrick’s thoughtful contribution; he did not raise the warm homes scheme issue but returned to an issue that he has addressed before — basic adult literacy and numeracy.
None of the ways suggested by the DUP to slice up the Budget alters the fact that the Department for Social Development did not present fuel poverty as a priority for either the Budget or the Executive programme funds. I referred Members to the position report issued in June, when the then Minister for Social Development tabled an amendment. Neither he nor his Department presented the matter as a priority. I hope that Members will appreciate that fact. In the bilateral meetings that we conducted on the Budget, the Department for Social Development did not give the issue priority. Given the extravagance and the exaggeration of some of the claims made in the Chamber, people should bear that in mind.
In December 2000, the Executive provided £2 million to allow the new warm homes scheme to proceed. The Department for Social Development then introduced the enhanced scheme without seeking additional resources from the centre. Warm homes are important, but we must remember that the current Minister for Social Development announced on 21 November that the £4·3 million that the Department was spending would rise to £8 million next year. That should be set in context. That provision is also part of a wider fuel poverty package that totals £12·5 million. It is not the case that the Executive have done nothing or that the Budget does not make provision to tackle fuel poverty.
The Budget recommendations reflect the level of priority that the Department for Social Development places on fuel poverty. If expenditure on the warm homes scheme is to double next year, it is for the Executive to consider any further proposals that the Department might make to reassess the level of priority given to fuel poverty in its own budget, in the Executive Budget or in Executive programme funds. Those issues can be considered on their merits as they arise. That is the proper way to show the importance of issues — not through gimmicky stunts and ambushes. What Mr Close said about the DUP’s amendment was right.
The Chairperson of the Finance and Personnel Committee, Mr Molloy, highlighted the Committee’s interest in the management of Executive programme funds. Mr Hussey suggested that money should go straight to Departments, rather than into Executive programme funds. Mr Close complained that there was some sort of syndrome by which Departments assume that the money is destined for them. They regard it as their money, and they do not think about the Budget’s wider priorities. Executive programme funds were created as an antidote to that syndrome. They were to ensure that we did not decide that we were dealing with fixed envelopes that could not be reprioritised between budgets. Executive programme funds have been a means to try to bring greater Executive strategic priority to the Budget.
Significant developments have come from Executive programme funds. However, the Finance and Personnel Committee was right to identify the need to improve the way in which the funds are planned, managed and accounted for through positive evaluation and reportage. The Executive will proceed on that basis, and they will follow some of the Committee’s sensible and helpful recommendations. Those recommendations do not move against the Executive programme funds, but they try to ensure that we make best use of them.
Mr Molloy also mentioned the needs and effectiveness evaluations. They are substantial pieces of work. The findings will be used to support our case on the Barnett formula, and they will influence our work on next year’s spending review. That work concerns our Departments as well as the Treasury.

Mr Donovan McClelland: There is a great deal of noise in the Chamber. Having asked the Minister so many questions, it would be unfortunate if we were not afforded the opportunity to listen to his response.

Mr Mark Durkan: Part of the work that will flow from the needs and effectiveness evaluations will address the points raised by Mr Close, Ms McWilliams and Mr Leslie. We must see whether we are spending money where it is most needed and where it will have the most impact on our regional needs, whether they be social, economic, environmental or cultural.
Members have queried many aspects of the Budget, and they have asked whether our tests for departmental budget bids have been searching enough and whether we have been thorough in our appraisals for Executive programme funds. I hope that those Members will join with us to ensure that we have honest and thorough reflection on the issues that arise from the results of the evaluations. There is no point in rehearsing the line that programmes must have the sort of spending that they have always had. There is no point in insisting that new needs must be the subject of new bids that may or may not succeed because limited money is available.
The total discretion that we have must apply to the entire Budget. Several Members said that we concentrate too much on the question of additional bids, and I agree. Ms McWilliams complained that too many allocations were announced and that that causes confusion. That is the price of transparency. If I tried to get away with fewer allocation announcements, said less, or said that we would save up the announcements until we have a nice aggregate, many people would say that matters were being obscured — rather than confused — and that they did not know what was happening. If people can follow it, there are clear and consistent patterns. I would prefer some of the major spending decisions that are taken by the Departments to be subjected to the same sort of scrutiny and exposures to which mere fractions of the total budgetary allocation are subjected. Considering the proportion of the Budget accounted for by Executive programme funds, and the level of scrutiny that that attaches to them — compared with some of the big decisions that are taken elsewhere — there are issues that need to be addressed by the Executive and the Assembly Committees.
Mr Leslie’s point about asset management is correct. It is not only an issue now; it will become a bigger issue because of the impact of resource accounting and budgeting. We, as an Assembly and not only as an Executive, must start to get our heads around some of the issues involved. Among the proposals to help the targeting of next year’s health budget was the suggestion that there would be £5 million worth of asset sales. On a previous occasion, some Members objected to that proposal and raised scare stories about the family silver being sold off. In trying to achieve asset sales of £5 million from a total asset holding of £3 billion we are not looking at the family silver being sold off, we are trying to identify ways to put more money into health, for which many Members have rightly pressed.
Points were made about the Department of Culture, Arts and Leisure’s budget. I understand that Department’s circumstances and that, historically, some of its programmes have been underfunded. The Executive have seen to it that major increases have been made in that Department’s funding programmes in the past few years.

Mr Donovan McClelland: I remind Members to my right that if they wish to conduct private conversations there is adequate space in the Great Hall.

Mr Mark Durkan: On behalf of the Committee for Agriculture and Rural Development, Dr Paisley mentioned the vision group’s report. There was an allocation towards the work of the vision group in a previous Budget, which was intended to be a pre-allocation of the Executive programme funds. The vision group’s review is now subject to consultation, after which proposals will be made. Any firm bids for implementing the report’s recommendations will be developed and considered in that context, with access given to Executive programme funds as is appropriate. The vision group previously received an advance allocation from Executive programme funds, which proves its eligibility for funding. The Executive must ensure that we take into account any necessary prioritisation in the Department of Agriculture and Rural Development. Its Committee often raises points on that matter.
The Executive also want to ensure that we do not just implement structures and policies in a new way, without knowing that they will deliver results. There is no difference between the approach to the vision group’s report and the approach to the soccer strategy. In both cases, funding will depend on satisfactory business cases being advanced.
Dr Paisley also raised points about compensation for the fishing industry and the impact of the fish quota cuts. He is aware that it has not been policy to compensate for reductions in quotas or for closures. The Commission’s proposals are unwelcome as far as the Northern Ireland fleet is concerned, and that has been reflected in the Minister of Agriculture and Rural Development’s fight for an approach that takes account of the industry’s difficulties while respecting the scientific evidence. She will attend next week’s Fisheries Council meeting.
Mr Close raised several issues. Some of them are familiar to Members because of his contributions in the Chamber. For example, he mentioned the regional rate. Others may be less familiar to Members because they have come via his contributions to the Committee for Finance and Personnel.
As regards the regional rate, I make the point again: where we recognise that we do not have enough money available as a block of expenditure to use at our discretion, we must supplement it from our own resources. If we are committed to public services and to public expenditure — and this Minister of Finance and Personnel is — we must be prepared to ask the public to make further contributions.
That is particularly relevant in the light of next year’s spending review. We are supposed to be raising issues about the Barnett formula, but we will be approaching the Treasury from a weak position, because less revenue is raised here by comparison with the contributions paid by households across the water. Many Members rail against the regional rate, while as councillors they vote for higher increases in the district rate. Accusations that some Ministers are inconsistent might apply equally to other Members.
Seamus Close is right that we need to attack bureaucracy and take action to improve efficiency and effectiveness. We must do more to ensure that resources are used in the best possible way. That relates to my earlier point on the application of scrutiny and the intervention of Committees to scrutinise.
I mentioned that we need more joined-up scrutiny so that such issues as are examined by the Public Accounts Committee, arising from the work of the Comptroller and Auditor General, are properly monitored. A more joined-up approach would ensure that the implications of those issues and the application of Departments’ commitments are properly monitored to ensure their full effectiveness. There are ways to ensure that that relays into the Budget process.
Several Members mentioned departmental running costs. I recommended to the Executive that they make a 1% cut in departmental running costs across all Departments — the Executive did, therefore, consider the issue. Committees’ responses to the position report and the draft Budget show that Departments and Committees identified that the term "departmental running costs" is sometimes a mislabelling of what those costs cover. For some Departments, departmental running costs do not simply relate to the bureaucratic costs of civil servants at the centre of the Department. In many cases, those costs cover direct, frontline service providers. That distinction should be recognised. For some Departments, the term is something of a misnomer. The Executive have recognised that they need to address that inaccuracy. The Committee for Finance and Personnel might want to address that also.
Some Members highlighted the increase in departmental running costs of the Department for Social Development. Those Members might have thought that they were helping me by making that point, but the significant increase in departmental running costs for the Social Security Agency is part of the welfare reform and modernisation programme. Investments are aimed at introducing new measures that will, in turn, yield savings over time. It would be unfair of me to omit that fact.
Members have welcomed the fact that the Executive have been able to do more for the Health Service, but I appreciate that Members are frustrated that the extra money will not be adequate to tackle all its problems. Members commented on the serious problems that they have seen when visiting hospitals and other services in either a personal or official capacity. We are investing more into the Health Service than is allocated under the Barnett formula.
I resent Boyd Douglas’s insinuation that, had it not been for the Chancellor, no more money would have been allocated to the Health Service or for care of the elderly. Prior to the Chancellor’s announcement of an extra £28 million in the pre-Budget report, the Executive decided to increase the Health budget beyond that provided in the draft Budget. In last year’s Budget I announced that the Executive would provide money for free nursing care for the elderly. Unfortunately, the legislation was not then in place. Other pressures also bore on the situation. No money was taken from the Department, but other pressures were able to absorb the money. However, with available extra money, we have been able to make good that commitment, and I hope that the Executive and the Assembly will facilitate that by passing the necessary legislation.
Unfortunately, because of time constraints, I have been unable to answer all of the points made by Members. I am usually criticised for trying to answer too many questions. I will certainly try to follow them up, as I have done in the past. I also hope that Members will follow up those points themselves in their respective Committees. I am fascinated by some of the points that Members have made to me as Minister of Finance about some discrete issues within their Committees. I would be even more fascinated to see some of those points pursued at Committee level and to see what results from that.

Mr Donovan McClelland: I must ask the Minister to conclude his remarks.

Mr Mark Durkan: I want to thank Members for their contributions to the debate. Some Members paid me compliments for my work as Minister of Finance and Personnel, and I appreciate those. The Committee for Finance and Personnel has helped the Executive and the Assembly to develop very effective and transparent arrangements for examining public expenditure planning and allocations, and I place on record my appreciation of its work. Our budgetary process is more transparent than that found in any other jurisdiction in this hemisphere. I am glad to have played some part in creating that, but I particularly pay tribute to the work of the Committee for Finance and Personnel. I hope that the Assembly will endorse the Budget.
Question put
The Assembly divided: Ayes 20; Noes 55
Ayes
Fraser Agnew, Paul Berry, Gregory Campbell, Mervyn Carrick, Wilson Clyde, Nigel Dodds, Oliver Gibson, William Hay, David Hilditch, Roger Hutchinson, Robert McCartney, William McCrea, Maurice Morrow, Ian Paisley Jnr, Mark Robinson, Peter Robinson, Jim Shannon, Denis Watson, Peter Weir, Sammy Wilson.
Noes
Gerry Adams, Ian Adamson, Roy Beggs, Billy Bell, Eileen Bell, Esmond Birnie, Joe Byrne, Joan Carson, Seamus Close, Fred Cobain, Robert Coulter, John Dallat, Duncan Shipley Dalton, Ivan Davis, Bairbre de Brún, Arthur Doherty, Mark Durkan, David Ervine, Sean Farren, John Fee, David Ford, Sam Foster, Tommy Gallagher, Michelle Gildernew, Tom Hamilton, Carmel Hanna, Denis Haughey, Joe Hendron, Billy Hutchinson, John Kelly, Danny Kennedy, James Leslie, Patricia Lewsley, Alban Maginness, Alex Maskey, Kieran McCarthy, Alasdair McDonnell, Alan McFarland, Michael McGimpsey, Eddie McGrady, Martin McGuinness, Gerry McHugh, Eugene McMenamin, Pat McNamee, Monica McWilliams, Conor Murphy, Mick Murphy, Mary Nelis, Dermot Nesbitt, Danny O’Connor, Dara O’Hagan, Sue Ramsey, Ken Robinson, Brid Rodgers, Jim Wilson.
Question accordingly negatived.

Mr Donovan McClelland: I remind Members that this motion requires cross-community support.
Main Question put.
The Assembly divided: Ayes 49, Noes 27.
Ayes
Nationalist:
Gerry Adams, Joe Byrne, John Dallat, Bairbre de Brún, Arthur Doherty, Mark Durkan, Sean Farren, John Fee, Tommy Gallagher, Michelle Gildernew, Carmel Hanna, Denis Haughey, Joe Hendron, John Kelly, Patricia Lewsley, Alban Maginness, Alex Maskey, Alasdair McDonnell, Eddie McGrady, Martin McGuinness, Gerry McHugh, Eugene McMenamin, Pat McNamee, Conor Murphy, Mick Murphy, Mary Nelis, Danny O’Connor, Dara O’Hagan, Sue Ramsey, Brid Rodgers.
Unionist:
Ian Adamson, Roy Beggs, Billy Bell, Esmond Birnie, Joan Carson, Fred Cobain, Robert Coulter, Duncan Shipley Dalton, Ivan Davis, Sam Foster, Tom Hamilton, Derek Hussey, Danny Kennedy, James Leslie, Alan McFarland, Michael McGimpsey, Dermot Nesbitt, Ken Robinson, Jim Wilson.
Noes
Nationalist:
Monica McWilliams.
Unionist:
Fraser Agnew, Paul Berry, Gregory Campbell, Mervyn Carrick, Wilson Clyde, Nigel Dodds, David Ervine, Oliver Gibson, William Hay, David Hilditch, Billy Hutchinson, Roger Hutchinson, Robert McCartney, William McCrea, Maurice Morrow, Ian Paisley Jnr, Mark Robinson, Peter Robinson, Jim Shannon, Denis Watson, Peter Weir, Sammy Wilson.
Other:
Eileen Bell, Seamus Close, David Ford, Kieran McCarthy.
Total Votes 76 Total Ayes 49 ( 64.5%) Nationalist Votes 31 Nationalist Ayes 30 ( 96.8%) Unionist Votes 41 Unionist Ayes 19 ( 46.3%)
Question accordingly agreed to.
Resolved (with cross-community support):
That this Assembly approves the programme of expenditure proposals for 2002-03 as set out in the Budget laid before the Assembly on 3 December 2001.

Health Service

Ms Carmel Hanna: I beg to move
That this Assembly urges the Minister of Health, Social Services and Public Safety to take urgent action to tackle the current crisis in the Health Service, particularly in view of impending additional winter pressures.
I look forward to a constructive debate on the future of our Health Service. Members share many concerns about the Health Service, and we also share a desire to help provide the best treatment and service. Today, we have an opportunity to explore ways of tackling the all-too-evident problems.
(Madam Deputy Speaker [Ms Morrice] in the Chair)
Every day seems to bring more bad news about our health and social services, and we appear to lurch from crisis to crisis. Sometimes, the Minister, her Department and the Committee for Health, Social Services and Public Safety appear to be overwhelmed by the multitude and complexity of the problems. However, we must know where we want to go and how to get there. That is the essence of a strategic vision. We want to achieve a real Health Service, not one for the inadequate treatment of bad health, but one that promotes a positive and coherent vision of healthy living and tries to anticipate our problems.
I support the amendment, but I must say that resources are only half the picture. A blank cheque is not the solution, and spending must be planned. The amendment may be a distraction from the constructive thrust of my motion.
Last week, the Department issued statistics on hospital waiting lists for the quarter ending 30 September 2001. Those statistics give added relevance to the motion, especially as waiting lists appear to be spiralling out of control even before the full impact of additional winter pressures is felt.
I hope that the debate will focus on the necessity for a shared strategic vision for the future of the National Health Service. There are 56,700 people on waiting lists. That is a disturbing statistic, and, more importantly, the annualised rate of increase is now approaching 14% — an increase of more than half on the annualised rate of increase only three months ago.
Waiting lists are one way to measure the pressures on the National Health Service, but I am worried that health professionals acknowledge that waiting lists alone are inappropriate to measure the effectiveness of acute hospital performance. The only foolproof qualitative criterion to determine a patient’s treatment is an assessment of clinical need. The pressures on acute hospitals to meet targets has placed undue emphasis on the performance of routine operations for more easily treatable conditions at the expense of patients who need longer, more complex and, ultimately, more necessary procedures. What concerns me most is that the waiting lists include many of the most difficult cases, and there is less of a mix than in the past. The resources required to reduce that bald statistic — 56,700 — may be enormous.
I have asked for an audit of waiting lists. I ask for it again. For example, the framework for action on waiting lists was supposed to reduce our waiting list to 48,000. The Department received £8 million accordingly. What were the findings of that framework? Where exactly did that £8 million go? Why did the problem get worse rather than better? Those are hard questions, and the answers may sometimes be embarrassing or awkward. However, we need to hear them.
At times, we appear to be rudderless and out of control. In such a situation, to simply call for more resources without knowing what they are to be applied to and what value that expenditure will add is missing the point. Since devolution, we have spent more than 40% of the block grant on health and social services — almost half of our Budget. In the first year, the finance allocated was £2·178 billion. For the current year, 2001-02, the allocation was £2·366 billion. Next year’s allocation from the Minister of Finance and Personnel will be £2·5 billion.
In the three years since devolution, the amount of money going to the Department of Health, Social Services and Public Safety has increased considerably and has been in excess of the rate of inflation. Despite those extra resources the position of the National Health Service in the North has declined. That is a substantial sum of money. Even though the vast bulk of it is committed beforehand, the Minister of Finance and Personnel has rightly noted that the Minister of Health, Social Services and Public Safety was successful with more than half her bids for discretionary initiatives that she wanted to undertake. In other words, resources are a problem, but they form only part of the bigger picture.
Waiting lists are an indicator of pressures in the acute sector. However, the unpalatable fact is that we in the North already spend a higher amount per capita, and a higher percentage of our total health budget, on acute healthcare than the Irish Republic or anywhere in England. However, our waiting lists are by far the worst of any UK region and are worsening all the time.
Those issues are being debated in the legislatures of every Western democracy. They are all faced with ageing populations and a seemingly limitless demand for health and social services. The questions that people in Northern Ireland must address regarding our Health Service are not unique. Some of them may be, but most are not.
I ask the Minister how we can match the finite resources available with an apparently ever-expanding need? How do we optimise the use of available financial and manpower resources? How do we plan strategically for the future use of trained and competent doctors, nurses, and other professions allied to medicine, as well as Health Service managers and appropriate medical facilities?
How do we lift ourselves off the bottom of the UK regional league table of performance indicators for long waiting lists, cancelled clinics, chronic heart disease, cancer rates and inappropriate lifestyles, as represented by excessive alcohol and tobacco consumption? How soon can we slim down and rationalise the Health Service structures between health boards and trusts? It must be done sooner rather than later. How do we restore public confidence in the bright shining vision of a National Health Service — as first articulated by Aneurin Bevan — as a universal, excellent healthcare system available to all and free at the point of delivery?
As someone who has worked in the National Health Service for decades, I want to make a difference, and I want to play my part. I am sure that every Member of the Assembly who is interested in health matters wants to do the same. Devolution means local people sorting out local problems with the maximum amount of democratic input. I am sure that the people who elected me to the Assembly would expect me to take my opportunity to be involved in that vision. One thing that Tony Benn said that always struck a chord with me was that the most socialist and popular act that any British Government ever carried out was to establish the National Health Service.
The types of healthcare procedures needed most urgently in this demand-led service, and the types of drugs and procedures now available, were largely unknown at the inception of the National Health Service in 1948. The service is a product of a different era and a different set of expectations. We can still preserve the integrity of the founding vision of the National Health Service, but we need to make hard choices to do so.
We have had the reviews and the consultations, now we must have an audit of performance. We must cost the decisions to be made in terms of people, manpower and resources, prioritise them and then make hard choices. As a member of the Health Committee, I have to express my frustration at the inertia and lack of decisions that emanate from the Department of Health, Social Services and Public Safety. The Minister has inherited an admittedly difficult, challenging and complex brief. She has had to cope with decades of underfunding, the postponement of hard decisions and the lack of political leadership. However, she is now in her third year of office and we seem to be going backwards rather than forwards.
At the same time, there appears to be a lack of imagination, leadership and vision in the Department. The Department’s role should be as a balancing act in the formulation of policy, advising the Minister and introducing legislation. Alongside that, in the hospitals and community care sector, we need the best possible Health Service managers with the appropriate knowledge and skills. That means that the Department must ensure that central priorities are met, while allowing the maximum possible scope for local initiative. It is easy to get bogged down in firefighting from day to day. However, if the Department is purely reactive we shall never break the vicious cycles and replace them with virtuous cycles. We shall never get anywhere.
The National Health Service is supposed to be a seamless, integrated and interdependent service that combines acute hospital and community care. However, we hear mostly about pressures on acute hospitals. We must never lose sight of the fact that more than 80% of healthcare takes place in the community. Healthcare is very much the Cinderella of the National Health Service.
The statistics on the uptake of flu jabs show that targets have not been met. Only around 50% of the elderly population have had the jab, yet I hope that that figure reaches 70%. If there is a flu epidemic, a winter crisis or a cold snap with an increase in fractures among older people, and staff in hospitals going down with flu, how will we cope? Will the perennial problem of the delayed discharge of patients be made worse because the community care facilities are not available? Will other patients who need acute procedures be unable to receive them because the beds for their planned treatments are occupied? And so the cycle continues.
We need to debate whether the current models of health and social services are appropriate and whether they have the capacity to address the complex issues of chronic sickness in an ageing population. There is clear evidence that the most chronic disabling conditions increase rapidly in incidence and prevalence with advancing age. In the next quarter of a century, the number of people aged 80 and over is expected to increase by almost 50%, and the number of those aged over 90 is expected to double. Those age groups have the greatest take-up of health and social services.
Now that the statutory sector no longer provides nursing and residential care for older people, we rely more on the private sector. Last week, we learned of a major private nursing home provider in Northern Ireland in financial difficulties, and we must ask why. Delayed discharges are symptoms of the gap in the total healthcare system in the interface between the acute sector and the primary and community care sector. Neither sector is equipped with the resources to deal with the needs of those with chronic health problems who require intermittent periods of treatment, rehabilitation, health monitoring and long-term care.
As a member of the Health Committee, I have learnt a lot by listening and talking to people about the National Health Service, whether they be patients, orderlies, ancillaries, nurses or doctors. The vast majority of health professionals want to deliver a patient-centred healthcare system, but they become frustrated by silly things like incompatible information and communication technology (ICT) systems. A properly functioning person- centred information system can reduce duplication, speed up the process and be very cost effective.
I wish to refer to the excellence of some of our local practitioners. At the top of their profession and esteemed internationally, they are harassed by having to cope with day-to-day pressures. Specialists with established international reputations return to the North, but they are disheartened by the chaos, the disorganisation and the lack of decision-making that confronts them.
The Department must audit practice. Where it is bad, it must be discontinued and where it is excellent, it must be replicated. We need a centre for clinical excellence here that will combine efficacy and efficiency, and recognise that current services vary unacceptably between different hospitals and trusts. With such a small population, 1·67 million, models and standards of practice need to be set so that unacceptable variations between hospitals are eliminated as quickly as possible. The best people in the Health Service, whether they be doctors, nurses, professionals allied to medicine, or managers, all need to have time to think strategically and to contribute to the vision of which I spoke earlier.
How can we expect to get the best from our staff if we do not facilitate professional development and allow them the time to think creatively to solve problems? Is it any wonder that the National Health Service is losing nurses to the private sector, which is costing us more than twice what it should, when working practices are so inflexible and family unfriendly?
The SDLP is the party of public services, but it is also the party of the competent management of public resources. The Committee for Health, Social Services and Public Safety and the Executive have demonstrated their commitment to the Health Service and their desire to work in partnership with the Minister to achieve a well resourced and properly managed service. We are here to help. We share the objective of prioritising health for all, but we need the Minister to meet us half way. She must acknowledge that finance is not the only issue and that receipt of more than 40% of the budget carries significant managerial responsibility.

Ms Jane Morrice: I have received one amendment to the motion, which is on the Marshalled List of amendments.

Mr John Kelly: I beg to move the following amendment: At the end add
"and calls on the Executive to make the necessary resources available to alleviate pressures throughout the Health Service."
Go raibh maith agat, a LeasCheann Comhairle. The amendment is not a distraction, as Ms Carmel Hanna suggests. It is an attempt to expand on her motion in order to make it more inclusive.
We agree with the sentiments of the motion, but it does not go far enough. The motion tends to curse the darkness, rather than light a candle of hope. I hope that all of us want to point to a beacon of light in the despair that engulfs the Health Service.
I hope that we shall have a constructive debate. However, health is an emotive issue. It is an issue that makes people angry and play games. We hope that no political games are being played with the health of the people of this part of the island.
"The scale of the problem should be acknowledged, as well as the resources and the time that will be required to address it".
That is a quote from an SDLP document, not a Sinn Féin document. Financial resources, whatever Ms Carmel Hanna says, are at the heart of the health crisis that we face, and if we harp on about mismanagement in the service we shall discourage investment in it. Members are here in an attempt to encourage investment in the Health Service.
The practitioners — the people at the coalface — know the reasons for the crisis. They know exactly where funding is required, and we who have spoken to them in the past year also know. Those people told the Health Committee how the Health Service should be managed, where it should be managed and what finances are required to manage it. There is no mystery about where the money is going in many cases. There may be a degree of rationalisation required in the trusts and boards. However, that is separate from the critical issue about which we talk today — the crisis at the centre of the Health Service.
The Committee for Health, Social Services and Public Safety, as Ms Hanna will be aware, invited the First Minister and the Deputy First Minister to discuss the financial crisis in the Health Service. The Committee has yet to receive a reply even though the Health Minister has stated that she welcomes its support in that matter.
The ability to provide the financial structures to meet the urgent needs of the crisis in the Health Service is a challenge to the collective responsibility of the Executive. The failure to provide those financial structures is a collective failure of the Executive, not of the Minister, in managing the Department. Events in the other part of Ireland prove that. Charlie McCreevy has provided the resources to finance a 10-year programme of health in the Twenty-six Counties. Gordon Brown is embarking on a similar strategic financial plan to assist in implementing health services in England, Scotland and Wales.
The Health Committee believes that health is the number one priority and, as such, supports the Minister’s assessment of an additional £122 million as the minimum needs for 2002-03. The Committee believes that those additional resources are required to deliver an acceptable level of healthcare, otherwise further pressures will be heaped on a sector operating at times under intolerable conditions. The Health Committee is saying that funding is required to the tune of £122 million, and in the current year that is £50 million short. Given all the moneys that have come from the Department of Finance and Personnel, that is still £50 million short.
Junior doctors recently passed a resolution that expressed grave concern at the progressive deterioration in services for patients due to delay in clarifying policy and adequately resourcing the Health Service. They believe that the Assembly needs to take up the issue of funding and ensure that health and social care is given higher priority. That is what the junior doctors say, not the Health Committee. Those at the coalface are saying that at the centre of the crisis is a lack of funding. That is where we are coming from and where we should be coming from — we should express our concern about the lack of funding that afflicts and affects the Health Service. That is what the Health Committee, junior doctors and the SDLP document has stated.
A consultant to whom I spoke recently compared the provision of financial services to the Health Service to putting money into a bottomless pit. He said that the answer did not lie in throwing resources into that pit but in finding a floor to that pit. Members realise that good money could be thrown after bad, and no one is asking that more good money be thrown after bad. However, Members must realise that there is a bottomless pit and the trick is finding the floor to it. Only then will it be possible to deliver, as the consultant said, an equitable Health Service to a greater number of the sick.
Again, the core question is funding. Sinn Féin would support a financially structured 10-year plan that is consultative as it develops, and which has at its centre the collaborative participation of those at the coalface — health consultants, surgeons and junior doctors.
We know from our meetings with clinicians, consultants, nurses and midwives, who work on the floor of the Health Service, that a collaborative approach is needed. It is not good enough that one discipline should compete with another. Given that this Assembly acts collaboratively, medical care providers should be asked to collaborate as a profession. Cardiac departments should not be fighting with orthopaedics or obstetrics departments; every element of the profession should collaborate to point the way forward for service provision.
Last week, during the day, it took me just six-and- a-half minutes to travel from Belfast City Hospital to the Royal Victoria Hospital. Those two major hospitals are situated minutes apart in the centre of Belfast, yet they operate differently and under different boards. The Health Service would benefit a great deal if those hospitals collaborated to provide the services that are needed in Greater Belfast. That is one example of an area in which an integrated approach should be taken. Again, the motion calls for urgent action to tackle the current crisis.
Does Ms Hanna refer to the £12·9 million allocation for extra community services, the £12·4 million for additional hospital services, the £2 million for additional children’s services, or the additional £8 million that will be made available in the current year to make a start? Alternatively, does she refer to the bid by the Minister for Health, Social Services and Public Safety for £50 million, which the Minister for Finance and Personnel did not provide?
The primary obligation of a civilised society with any notion of its responsibility to its citizens is to provide for the sick and to find a cohesive and collaborative way to attack the problem. That should not be done disparately, or simply through targeting a Minister or even the Executive; providers should come together to heal the sickness in our society.
The people’s health is the central responsibility of Government. Their success can be measured according to the quality of life of its people. For too long, sections of our community have died younger, suffered increasing ill health longer and battled daily. They exist rather than live. The public and hospital staff are disillusioned by the uncertainty of the crisis management of the Health Service. They are ready for a change, and they demand change. The end to crisis management requires funding that addresses realistically the crisis, not crisis funding.
I call on the Executive to make the health of our people their number one priority and to finance in full the bids made by the Minister. Failure to act now will result in a greater crisis of confidence that will further undermine the crumbling foundation of our Health Service.

Ms Jane Morrice: Members will be aware that there is much interest in the debate and that many Members wish to contribute. The Business Committee has allocated three hours for the debate. Therefore, in this first round, I urge Members to restrict the length of their contribution to eight minutes and in the second round I shall recalculate.

Dr Joe Hendron: As the Chairperson of the Health Committee and after — I hate to say it — 40 years of experience in primary health care, this is a subject about which I know, and about which I feel strongly. I welcome the motion put forward by Ms Carmel Hanna, and I welcome the amendment also.
In his amendment Mr Kelly uses the word "alleviate" and thus accepts that money itself cannot reverse the situation, despite gross underfunding of the Health Service over many years. There are problems as well as financial constraints.
There is a major crisis in the Health Service every day, and it still has to face the difficulties of winter. Direct rule Minister, Mr McFall, introduced two documents in 1999, ‘Putting it Right’, which related to acute hospitals, and ‘Fit for the Future’, a new approach to future primary care. Massive consultation was carried out, and both documents were prepared for the Assembly. I appreciate that they are mentioned from time to time, but generally they have been pushed to one side, and we have review document after review document for consultation.
There is a crisis in cardiac surgery services — we read about people being sent to Germany and other places for operations. Last year 18 people died while on the waiting list for cardiac surgery. We have had reviews of that. A cardiac surgeon’s job was not advertised although it was known for a year that he would be retiring. I do not know what happened about that post.
The fracture service is available only in Belfast and Derry. The level of staffing and facilities available for trauma and orthopaedic services is the lowest of any National Health Service region. The waiting times for treatment of fractures are appallingly long. The average time between admission and surgery for hip fracture patients in the Royal is between five and six days. As a medical student I was taught that a fracture to the neck of the femur should be dealt with within 24 hours, because a patient’s condition deteriorates after that, and, if he does not die, his quality of life is reduced. In Scotland the waiting time is two days, whereas here it can be up to five or six days.
There is gross inequity for patients, with injuries, who go to hospitals outside Belfast or Derry — for example, to Craigavon and Antrim. If an elderly lady is admitted to Antrim or Craigavon with a fracture to the neck of the femur, which happens frequently, she will probably have to wait five or six days for a bed in the main trauma hospital. The elective orthopaedic facility in Musgrave Park is bursting at the seams. I could go on, but time is insufficient.
In all hospitals within 20 miles of Belfast, the situation is the same in the accident and emergency departments. Recently, Monica McWilliams and I visited the Ulster Hospital, where the situation is horrific. People were waiting on trolleys and chairs. A nursing sister was in tears when she told us of one poor man who had been in a chair but was so concerned about the welfare of the staff that he did not want to call them and so soiled himself.
We visited the Royal and the City hospitals recently where the situation is the same. Dr K E Dowey, the senior accident and emergency surgeon in the City, wrote to the Chief Medical Officer and said that the situation with acute beds was critical and that the staff were on "take in" daily. She said that lying in an accident and emergency corridor for up to 24 hours was totally unacceptable for patients, who sometimes have to be nursed all night there. The stress and strain on the staff is intolerable, and morale is at an all-time low. Young doctors cannot be attracted to accident and emergency work, and young nurses are leaving almost weekly.
Dr Ian Carson sent a letter to every doctor in Northern Ireland in primary care about the regional neurosurgery service in the Royal Victoria Hospital. It said
"The net effect of the problems are that our surgical capacity is limited almost completely to emergency and clinically urgent cases and consequently very few, if any, elective patients are being admitted."
Where is the seamless transition in primary care where 90% of all patients are treated? Last January, the Committee for Health, Social Services and Public Safety tabled an amendment on fundholding, the purpose of which was to allow seamless transition. I welcome the Minister’s decision on the new primary care groups, but I do not see the seamless transition that is to take place between now and 1 April.
The sad thing is that the people of Northern Ireland deserve the best. Last January I said that we would not have another opportunity to get primary care right for several years. I still believe that we have a chance to do that. If we do not get primary care right, we will not get acute hospitals or other secondary services right either.
Nine per cent of all outpatient clinics are cancelled. Some are cancelled for good reasons, others for not so good reasons. Waiting lists were referred to. The latest figure quoted was 56,000 people on waiting lists, and the number is rising. The Executive and the Minister of Finance and Personnel seem to have got the message, judging by their statements and the recent allocations to the Health Service. For example, Mr Durkan revealed an increase of £205 million in allocation for 2002-03 to health and social services. That is an increase of 8·9% over the 2001-02 allocation, giving a total of over £2·5 billion. Substantial increases in funding have been made, but it is still not enough.
On 3 December, the Minister of Finance and Personnel told the House:
"It is not enough simply to put money into the Health Service. Many people rightly ask how the resources that have already been provided have been used. …As with all public services, there are problems with management and efficiency which must be addressed. The way in which the services are organised begs many questions. Hard choices must be made which will affect the standard of care and the nature of hospital provision in the region." — [Official Report, Bound Volume 13, p.190]
Ms Hanna referred to the audit. Recently, some colleagues and I met with the Auditor General of Northern Ireland. He informed us that he has responsibility for the supervision of all Departments, excluding the Department of Health, Social Services and Public Safety. I do not pretend to understand the historic reasons behind that, but the situation must be corrected.
The Committee wants to work in partnership with the Minister of Health, Social Services and Public Safety. We worked together on the new cancer centre. The Committee tried to be as helpful as it could, and it believes that the funding will be found. I agree with what Ms Hanna said about the overall strategy for the Health Service. We want to work with the Minister in the spirit of public service, but the Minister must meet the Committee halfway. Finance is important but it is not the only issue.

Ms Jane Morrice: The Member’s time is up.

Rev Robert Coulter: I thank Ms Hanna for proposing the motion. Ultimately, it concerns every home and every person in the country. The subject has given the Assembly much to think about in the past. In particular, the Committee for Health, Social Services and Public Safety has looked in frustration at so much that seems to be wrong in the Health Service. We have heard many speeches about the things that are wrong.
Three issues in the Health Service must be examined. First, there is the structure of the service. There is no need for a huge Department, four boards, 19 trusts and countless agencies. In England, one board controls areas that have a population exactly the same as ours.
Duplication in administration has been mentioned. When one examines the salary scales of the senior officers in trusts and boards, one sees immediately where the haemorrhaging begins in departmental funds. In the present structure, the perception that is given of wasting finance is such that it casts despair into the hearts and minds of patients waiting for operations, who read in the local papers that an officer is being given a rise of £25,000 per year. The whole structure of the service needs to be examined.
We have been inundated with consultancy documents and bombarded with review documents. However, ultimately it seems that very few decisions are made. It is not a question of tinkering with individual sections of the Health Service: the entire structure needs to be examined, reviewed, and changed.
As the Assembly reviews the problems in the Health Service, the second matter that should be examined is its strategy — or the lack of it. One is tempted to ask, "What is the strategy of the Department of Finance and Personnel?" When we begin to enquire about the audit trails within the Health Service we run up against a brick wall. Money is given to the boards; the boards give it to the trusts; the trusts dispense it. As I remarked to the Minister of Finance and Personnel during the Budget debate, money becomes confetti currency within the Health Service. It is impossible to even begin looking at the audit trails never mind trying to follow them.
One is tempted to ask questions about the bonus system for managers. Comparing the salaries of nurses who are on the wards with those of managers who sit in offices, the perception is that the service is being run for the latter. It is not being run for patients, or for the nurses who are dispensing the service. The service is being structured by a strategy that deals only with finance.
I suggest that when communities find funds to provide equipment, the Minister and the Department should match that funding — pound for pound. There would then not only be accountability for community funding; the communities themselves would share in the accountability for the funds they would be given by the Department.
I mentioned the Health Service structure earlier. What is the strategy behind a structure in which one trust covers a fifth of the entire population of Northern Ireland? There is something wrong when only one out of 19 trusts is tasked with the community care of the people of Northern Ireland to that extent.
There is no question that there has been competition in the Health Service, and that is a huge drain on funds. Is it the Department’s strategy to continue competitiveness among various areas of the Health Service? The Chairperson of the Committee for Health, Social Services and Public Safety has already mentioned this point. Everyone should be working together. The strategy should be clear, and everyone should know exactly where he or she is going. Where are the "care trails" within our Health Service? When a patient asks how he or she will be treated how often can that patient be told the trail that they will follow back to health?
There are three distinct sectors within the Health Service in Northern Ireland — acute care, community care, and primary care. We have discussed accident and emergency units associated with the acute sector, and we have seen the difficulties there. It is not acceptable when an ambulance is left sitting for 45 minutes because the stretcher has been taken from it for a patient to lie on in an accident and emergency unit.
Staff are leaving the Health Service to work abroad. Is that because the grading system needs to be changed? At the last conference of the Royal College of Nursing, that issue was brought to the fore. Until there is a situation where services are patient-driven and not finance-driven and where all of us — the Minister, the Department, nurses and consultants — are working together, we will not be able to make any change to the service. I support the motion.

Mr Paul Berry: I commend the proposer of the motion. It is one in a long line of motions on the Health Service, although it is important to highlight the serious problems within it and how best to deal with them.
The state of the Health Service has become synonymous with the words "crisis", "disaster" and "despair". Newspaper articles on the Health Service since January this year all describe bed crises, cancer crises, staff crises, fracture crises and casualty crises. Sadly, the list goes on.
In November last year, the Chairperson of the Health Committee, Dr Joe Hendron, expressed concern about the crises in the Health Service. In October and November of this year, he again expressed shock at those crises. In other words, nothing has improved at all. Health is among the most frequently debated matters in the House. That in itself demonstrates the widespread perception across the House that things are not only bad but that there is no sign of any improvement. In March last year, the Minister said that waiting lists were a top priority, yet they are still a major problem this year. No improvement has taken place, and things are getting worse.
Complaints over cancer services continue unabated. There is to be another consultation, which should silence those complaints for another six months — that is the perception, and it is the line that the Department is taking.
We can all highlight different areas to portray the shambles and demoralisation in the Health Service. Problems facing junior doctors is one area that emphasises, in a very real way, how widespread the rot is. The lack of cover, combined with a general shortage of doctors, simply means longer hours for those who are available to work.
The Health Committee recently met the British Medical Association and the spokespersons for junior doctors. One junior doctor told the Committee that, on one day, he worked 21·5 hours solid because there was no one on duty after him. That is hardly something to recommend, considering the risk to both patients and staff, as well as the strain upon the doctor in question.
The junior doctors’ spokesman, Dr Peter Maguire, recently highlighted the problems. His concerns must be carefully listened to and heeded. He said that problems are continuing to amount at a worrying rate, that the situation is threatening to spiral out of control and that the Health Service is heading for meltdown and the winter crisis has not even begun.
He went on to say that waiting lists and the numbers of patients waiting on trolleys are increasing because there are no spare beds in hospitals. Something must be done soon to sort that problem out. Winter is approaching. If there is a flu epidemic, people will die. Dr Maguire said that we are currently on the road to nowhere, that the Health Service is in tatters and that we must get our act together. Time after time we have raised the same concerns in the Chamber.
This situation is not acceptable. Do we want to hear it all again next year, the following year and the years to come? At a time when waiting lists are already at an all-time high, non-emergency operations have been cancelled in hospitals throughout the Province. The number of patients who have been waiting for up to two years just for a scan has not been reduced, and the problem continues.
Extra money is essential if we are to deal with the crisis. Recently, the chief executive of the Southern Health and Social Services Board said that local services were suffering. He went on to say:
"We simply do not receive the amount of money we need to provide an adequate service…The lack of investment has resulted in little better than Third World standards in parts of the system."
Besides the extra money, there is another essential ingredient. Management, from the top down and across the spectrum, is an area that is easily overlooked. We should consider again the language used by Dr Maguire about our Health Service: he talked of meltdown and said that the Health Service was
"currently on the road to nowhere"
and "in tatters".
That underscores the role of management. There is a question mark over the current management of the Health Service. There are new initiatives of one sort or another, and reviews of all kinds of things are announced; it seems that any kind of activity is the goal, whereas overall, managed delivery is irrelevant. The situation lacks focus and perspective.
I welcome the money that will go towards providing free care for the elderly. There is, however, a wider perspective. If private nursing and residential homes continue to close because the fees paid are inadequate, how much better off is our Health Service? If the elderly are kept in hospitals because there is no money for care in the community and there are no beds in the private sector, how are we better off? I know of two homes in my own area where relatives are asked to pay £15 more per week because the fees do not cover the cost of care. An overall perspective would take all the relevant issues into consideration at the same time. That does not happen with the current piecemeal approach.
When the Department of Health, Social Services and Public Safety issues a press release about a new initiative or extra money, it takes its cut, and the remainder is passed on to the trusts, even though it is not enough to allow them to carry out their task. No time is taken to check on progress or establish what improvements are needed, before yet another initiative is announced or a press release issued. There is a widespread perception that neither the Minister nor her Department is seriously interested in solving the crisis and that they exist simply to produce new rules, initiatives and procedures — in other words, red tape. The actual delivery of services, which is grossly underfunded, is ignored.
The motion calls on the Department of Health, Social Services and Public Safety to take urgent action to tackle the crisis. Meanwhile, cancer services, cardiology services, orthopaedics and staff morale deteriorate. The maternity service is lost in a maze of consultations. Our Health Service is not being managed.
The Department of Health, Social Services and Public Safety has no overall strategy to resolve the crisis. Management has no will to succeed, and the trusts do not have the resources to deliver the service. Until all those matters are resolved, the current shambles will remain. I commend the nurses, doctors and the professionals in the service.

Ms Michelle Gildernew: Go raibh maith agat, a LeasCheann Comhairle. I listened carefully to the points that have been made, and I welcome the chance to discuss this vital area. Morale in the Health Service is very low.
Our doctors and nurses work in a system that has been underfunded for many years. Successive British Ministers travelled in and out, making decisions that affected all of us. Some of those decisions were good, but very many of them were bad. They knew that those decisions would never cost them a single vote. For the first time in my life, directly accountable, locally elected representatives can make such decisions, but they must live with the legacy of a lack of resources and accountability, and there is much work to be done to bring the Health Service up to the standard required by the Minister.
The Health Service is still a sick organisation with insufficient staff, poor facilities and too few beds. Those problems, combined with a lack of community consultation and a policy of papering over the cracks, mean that there is a mountain to climb. As a result, money has been taken out of children’s services and community care and put into the bottomless pit of acute services — without adequate planning.
The imagination and confidence to think "outside the box" are needed. I welcome good projects such as the breast milk bank; they should be encouraged. However, social issues such as fuel poverty should also be addressed as a matter of urgency to cut down on hospital stays, inhaler and antibiotic use and absenteeism from either school or work.
We should all work to tackle poverty and the social and economic conditions that impact on the health of our constituents. Fermanagh and South Tyrone has one of the highest rates of heart disease and cancer in Ireland, and it is no coincidence that it also has less economic investment, fewer public service jobs and some of the worst housing conditions in the Six Counties. It is little wonder that the health of my constituents is bad, but it will take more than investment in the Health Service to rectify that. A holistic and integrated approach is essential, and every Minister must take responsibility for that.
I welcome the Minister and the Executive’s initiative to provide over 1,000 community care packages to free up acute service beds. I have raised that issue with the Minister; it is a direct reversal of previous policy, and as a result, the Health Service and the Executive are targeting an area that was starved of resources by previous Administrations.
However, the Minister cannot magic doctors, nurses and consultants out of a hat. She needs the time and resources to turn round 30 years of rundown in the Health Service, and that cannot be done overnight. The service that she inherited had become so debilitated in the years before her tenure that she has had to try to halt the systematic closure and rundown of our local hospitals by the people who we trusted to run them.

Mr Danny Kennedy: Will the Member give way?

Ms Michelle Gildernew: No, I do not have enough time.
I listened to Members who raised the issues of duplication, administration costs and the waste of resources. That is the system that the Minister inherited, and that is the system that both the Minister and the Executive must try to change. It is a shared responsibility, and the Executive must rectify the mistakes of the past by working with the Minister.
There are two fundamental facts that we cannot change in a short space of time. In the past 30 years, the Health Service has been starved of hundreds of millions of pounds. A culture of bureaucracy has developed as a result of the Thatcherite agenda, the internal market and the trusts that have taken money away from front line services and primary and acute care. As an added complication, we have too few nurses, doctors and paramedics. At last the Executive have begun to respond to the Minister’s demands for more cash. However, during the lifetime of the Assembly, the Minister has only been allocated a fraction of the amount that she bid for, and that is the responsibility of all Members of the Executive.
I welcome the chance to participate in the debate. I support the amendment. Go raibh maith agat.

Mr Kieran McCarthy: I thank Carmel Hanna, John Kelly and Sue Ramsey for bringing this important matter before us today. It is the opinion of a great many people that the Health Service has been in crisis since Thatcher got her hands on the reins of power over two decades ago. That infamous British Prime Minister, with her Tory dogma, did away with hospital beds and staff throughout the National Health Service left, right and centre. She created unlimited management structures and introduced fat cats who were only interested in feathering their own nests. As Rev Robert Coulter said, she created huge bonuses for selected medical professionals. All those policies were to the detriment of the ordinary men, women and children who require decent health provision when they fall sick.
Today, those disastrous policies continue to haunt the Health Service. Everyone who tries to maintain any semblance of giving their best is undermined by the lack of funding, staff, space, equipment, drugs, et cetera. I have heard of an occasion when a patient asked for an extra pillow. The patient was told that the hospital had none to spare, and that one would need to be brought from home or bought. That is the state of affairs in the Health Service — it is disgraceful. There are many more such instances, and nurses and ancillary staff could tell other stories that would make the Department of Health hang its head in shame. That must stop now.
For many years, the waiting list to be admitted to hospital has been increasing at a faster and faster rate. However, the waiting time for patients to see their GPs has also been increasing alarmingly. That situation disadvantages the ordinary patient, and causes enormous anger and frustration.
The same shortages exist across the whole range of health services. There are shortages in cancer care, in services for people with learning difficulties and in services for the elderly. The list goes on and on. Despite the extra funding that is poured into the Health Service, we are going further down the road towards a situation in which we will be unable to provide a reasonable service to the community.
The public cannot understand why the Health Service has deteriorated to such a dreadful extent. Is it because of the need to cater for modern, almost self-inflicted wounds, such as illegal paramilitary activity, drug and alcohol abuse, drink-driving accidents, et cetera? Such modern-day activities must soak up a significant amount of funds, hospital beds, and doctors’ and nurses’ valuable time. An audit of self-inflicted health disorders might prove useful, and might be an appropriate way to prevent such accidents happening in the future. The resources could be redirected to those who fall sick, and who expect and deserve a nursing service that can make them well again.
Some time ago, the Government adopted a policy of care in the community. That was accepted as the way forward. Unfortunately, once again, insufficient funding was put in place to ensure that that policy ran smoothly. There are currently more than 70 people in the Ulster Hospital who should be out in their communities. However, due to the lack of funding for community care packages, those beds in the Ulster Hospital are still occupied. The result is ever-growing waiting lists, which creates unnecessary suffering. That state of affairs is probably replicated across Northern Ireland. I appeal to the Minister to do as much as she can to ensure that improvements are made.
I pay tribute to those people in rural communities who are fighting to keep their local hospitals open. They must continue campaigning. My constituency lost Ards Hospital and Bangor Hospital. At the time, we were promised that the Ulster Hospital would provide the same services. However, that was 10 years ago. Those services were never provided at the Ulster Hospital, and we are left in this predicament. Rural communities must be warned that the same will happen if their local services are closed down. I appeal to the Minister to get on top of the situation. It is not her fault — she inherited the problems. However, she has the opportunity to do something about it, and I ask her to do so.

Mr Denis Watson: I thank Ms Hanna for tabling the motion. Unfortunately, unbearable pressures impinge on the Health Service all year round. The current crisis is the result of years in which no decisions were made and there were too many reviews that promised action, yet failed to effectively deliver on those promises because we were unable to develop appropriate mechanisms.
Funding for the Health Service in Northern Ireland remains inadequate. It must be distributed equitably across the Province, not only to selected hospitals. The proposed investment in the service is only a drop in the ocean; significant long-term investment is needed. Putting money into the Health Service during the year is not a solution to funding problems. The service must be properly resourced, and managers must be aware of the level of resources available, so that the service can be properly planned, run and maintained. Craigavon Hospital, the Ulster Hospital, Altnagelvin Hospital and the Royal Victoria Hospital currently require major investment to upgrade and update facilities, estate and infrastructure in order to manage the current and expected growth in demand.
We need an urgent commitment to development on the Craigavon site, which alone requires £80 million. Although that amount will help to address the hospital’s long- term problems, it will not alleviate the current pressures.
Unacceptable trolley waits are a stark example of hospitals’ lack of capacity. The issue was highlighted in an article in the ‘Belfast Telegraph’ on Saturday, 8 December 2001, which reported the story of an 81-year-old woman who waited on a trolley for 22 hours in the Royal Victoria Hospital. It read:
"She lay overnight on a trolley in a corridor, without even a pillow. By the morning she was in a ‘distressed and confused’ state."
When her son asked when his mother would get a bed, he was told that 21 patients were on the list before her. Her son rightly says that he is enraged and bewildered, but pays tribute to the hospital staff for doing a marvellous job in difficult conditions. Surely those unacceptable trolley waits represent an unsafe environment for patients and staff and must be tackled urgently.
It is simply appalling that there were 27 trolley waits of more than 18 hours in Craigavon Hospital two weekends ago. The staff in the accident and emergency unit work under difficult conditions due to the long overdue and ongoing building work in that department, and they are to be admired for their level of commitment and service.
Bed capacity problems are evident across the Province. The main hospitals do not have the beds, staff or resources for the number of patients that currently require treatment. That is evident in the long and growing waiting lists. The main hospitals in Northern Ireland have the biggest demand for services, yet some of our smaller hospitals have less demand and much shorter waiting lists. That discriminates against people waiting for treatment at the larger hospitals.
The Hayes review highlighted new management structures for hospitals, but that is likely to take years to implement. Can the management teams of the various hospitals work together more closely to ease the inequalities in accessing the service?
The pressure on acute hospitals has been well documented. In Craigavon, more than 90% of admissions are emergencies. Therefore, little elective or planned work can be carried out. However, the waiting lists are shorter in neighbouring hospitals such as Lagan Valley Hospital and Daisy Hill Hospital. Surely it is time to utilise the under-capacity in some of those hospitals. The Minister must acknowledge that, with limited capacity across all hospitals, necessary emergency work must be a priority. Alternative measures must be found to manage the planned work and reduce the unacceptably long waiting lists. That would affect the current policy of short-term waiting list initiatives that manage relatively few patients and that do not make a long-term difference.
We need a long-term sustainable plan as to how to more effectively manage elective surgery. It is apparent that the legacy of downgrading some hospitals has fuelled a crisis in others. That has been the case in my area, where Craigavon Hospital has taken over the workload of South Tyrone Hospital. The Health Service is always blighted by bad publicity and there are difficulties in recruiting nursing and medical staff. Experienced staff are leaving because of low morale and lack of job satisfaction, and that, in turn, impacts on the remaining staff and makes it difficult to sustain even current levels of care. That matter must be addressed urgently if safe care and quality of care are to be maintained and improved. In spite of all that, Craigavon Area Hospital Group Health & Social Services Trust is to be congratulated on its new Macmillan building catering for cancer day patients. The planning of the building involved staff input, which resulted in a clearly patient-centred and congenial environment. The provision also avoids the need for many people in the area to take that long haul to Belfast.
The Hayes report sets out a view of the way ahead for the Northern Ireland Health Service, yet there is no sign of it being seriously considered or discussed with a view to implementation. The Health Service needs to take immediate decisions on the way forward. Decisions have been postponed for far too long. The service, as we have already said, is in a state of crisis, with pressure all year round, never mind the impending additional winter crisis. Repeated reports, consultations and reviews, et cetera, without the necessary action being taken to rectify the identified problem, only compound the crisis. The situation is not acceptable — our people deserve better. The service needs urgent action, not more promises. I support the motion.

Prof Monica McWilliams: Today for the first time, I voted against the Budget — probably the only designated Nationalist to do so. I voted against that Budget because the Executive did not take sufficient account of the Assembly’s concerns over the Budget’s allocation to health. I felt that I could not continue to highlight the concerns of my own constituents — and the concerns of those whom I visit outside of South Belfast — on that matter, and then come to the Chamber and say that sufficient money was being made available.
We are only addressing the issue of money. However, if the resources continue to remain so inadequate, then all we can see in the future is more of a run-down service. When I became a Member of the Assembly, and when devolution came to Northern Ireland, I certainly thought that we could uphold the standards of the National Health Service, and tell people that we could bring them a decent quality of life and good services on the ground. I still hold on to that hope. However, unless we make health the number one priority in the Executive and in the Programme for Government, we are only creating more rhetoric among ourselves by believing that what is handed down to us in the Budget will fix the problem.
Dr Hendron said that both he and I had visited the Ulster Hospital a few weeks ago. We hoped that changes would have taken place by now. However, we have once again found that there are 73 delayed discharges — the equivalent of three hospital wards. Three full hospital wards have patients in them who are waiting to be discharged. As a consequence, the back-up that we saw that morning — 29 people on trolleys — occurred again this morning. We found that the ambulances could not go out because their trolleys were being used. The ambulance staff, the nursing staff, the medical staff, and those on the wards were all in crisis. They were managing one crisis on top of another to the point where they were under incredible stress. They were considering closing the hospital to admissions that morning.
That is not the type of Health Service that we should be establishing in Northern Ireland at this time of year. If that situation continues, people will seek jobs elsewhere; they will leave the service and morale will decrease further. We know what the solution is. We know that if we can get acute care, community care, domiciliary care and residential care all working together in an integrated Health Service, we shall be able to start releasing the boiling points before they actually blow the whole system wide open. However, we have not even begun to put that package together.
I welcome the announcement by the Minister of the 1,000 community care packages, and I sincerely hope that she is not once again in the position of having to take money from elsewhere in the service to provide those additional packages. Those servicing the provision of community care packages tell me that they are having to wait until a client dies before another package can be offered. They wait for an elderly client to pass away, thereby freeing up a care package. That is an incredible position in which to put any practising professional.
An enormous concern is that 20 independent residential homes closed in the past year. The cost of domiciliary and nursing home care has increased, but the Health Service has been unable to increase fees to recover that deficit. That has resulted in a huge argument about nursing care and consequent closures. That sector used to be described as being a profit-making one, but now providers cannot break even. At a time when the elderly population is increasing, nurses and social services staff cannot find them places in those homes, because those homes have gone. There is an increasingly vulnerable community of over 80s, who are looked after by the over 60s. We cannot find places in nursing homes for the over 80s, so if the over 60s get ill, both groups will end up in hospital.
The waiting list target to constrain the hospital waiting list to the March 2002 level by March 2003 must be changed. We do not yet know the March 2002 level, but we know that there is a current list of 56,000 people, and that is rising. One reason for that increase is that tonsillectomies had to be cancelled because instruments needed to be decontaminated.
The needs and effectiveness evaluation must be carried out urgently so that we can understand the source of those difficulties. A serious task force is needed to relieve those pressure points so that people can integrate and co-ordinate their services in a way that at one time was possible. I appreciate that, in moving the motion, Ms Hanna has realised the seriousness of the matter; I shall support it and the amendment.
Day after day, those who work in the Chest, Heart and Stroke Association telephone us to tell us about an emergency or about a patient in a dire situation. There are 600 people on its waiting list, an increase of 50% in the past five years. The organisation pointed out that more than twice as much money was available in England than in Northern Ireland, despite the Minister’s announcement in October. Therefore, the backlog and that organisation’s current concerns cannot be addressed.
There is a shortage of intensive care nurses. More perfusion technicians, who are responsible for the control of blood supplies during operations, are urgently required. There is a shortage of anaesthetists and many other specialists. We recently visited the trauma and orthopaedic surgeons in Musgrave Hospital, who told us that young professionals are waiting abroad to come home to take up those posts, but that they cannot be attracted back. Others leave because not enough specialist operations are carried out to keep their skills up to date. That must be addressed.
I am opposed to the top-slicing of the Department’s budget in the Executive programme funds. It is not good practice to allocate three years of funding for a service that should be funded from the core mainstream budgets. Those include the brain injury unit or the medium secure hospital at Knockbracken Healthcare Park. Those facilities should be core-funded, but the services with inescapable pressures that receive non- recurrent funding must be made recurrent; they should be made mainstream. That is the reason why I did not support today’s Budget. We must avoid duplication, tighten up the administration, integrate the services and increase those funds urgently.

Mr Robert McCartney: I support the motion. The Assembly has heard some excellent speeches today from Ms Hanna and Prof McWilliams, among others. Essentially, they have addressed the factual situation. We now know that the Health Service is on the brink of disaster, that there are huge waiting lists, and that oncology, cancer, heart, stroke and orthopaedic acute services are, in many cases, on hold. There is no development; people are dying. We must address the concepts behind this crisis. Only by thinking about why we are here and how we can possibly emerge from a bad situation, which all are agreed now exists, can anything be done about it. The speech that I shall make in this limited time is entirely different from the one that I anticipated making. The anticipated one was essentially factual, but the facts have been more than adequately covered.
Let us look at what the speeches that have been made, the motion and the amendment tell us. The SDLP motion essentially urges the Minister of Health, Social Services and Public Safety to take urgent action, placing the responsibility for doing something about the situation on the Sinn Féin Minister. The amendment suggests that there is not enough money and that the Minister is not to blame because her Department is under-resourced. Mr Kelly tells us that what it should do to cure that is finalise in full the bids of the Minister to the Department of Finance and Personnel. The suggestion is that it is the responsibility of the Minister of Finance and Personnel, as he is not providing sufficient resources for the Minister of Health, Social Services and Public Safety to do the job.
The Rev Robert Coulter then got up on behalf of the Ulster Unionist Party — the party of the First Minister and three other Ministers in the Executive. He suggested that the whole structure needs to be reviewed. We have a large and expensive Department, four boards and 19 trusts, which makes us grossly over-bureaucratized when compared to the likes of Birmingham, which has a similar population and one trust.
What does all this mean? It means that the fundamental structures of Government — not of health — lie at the source of our indecision and difficulty. John Kelly asked why we do not take a leaf from the book of Charlie McGreevy, the Minister for Finance in the Republic, who has a 10-year spending plan for the rehabilitation of medical facilities in the South, or even Gordon Brown. Mr Kelly fails to realise that those people, whom he wants us to emulate, are masters of their financial resources and not merely the dividers of a limited cake provided by someone else.
Mr Kelly calls upon us and the Ministers to think about collective responsibility. Collective responsibility has always been missing from this form of devolved Government. There is no such thing as collective responsibility. That is why the SDLP suggests that the Minister of Health, Social Services and Public Safety is to blame and Sinn Féin suggests that the Minister of Finance and Personnel is to blame for not providing sufficient funds. That is also why the largest party, the UUP, has asked the Department of Finance and Personnel’s strategy — the audit trails cannot be identified, let alone followed.
If we want to cure the problems in the Health Service we must look at the structures of Government. That is where it all begins — with the failure to have any collective responsibility. We need a First Minister who can take responsibility, say where money is going to be spent and direct policy. Instead, we have a collection of disparate warlords, all looking after their own portfolios.
I recall Prof McWilliams once talking about people ganging up on the Minister of Health, Social Services and Public Safety. That is what happens all the time here, because there is no collective responsibility, and without it, in this failed and defective system of Government, one will never get the facilities to address core problems such as there are at present.
We must set up an emergency committee that consists of the First and the Deputy First Ministers, the Minister of Finance and Personnel, the Minister of Health, Social Services and Public Safety, and the Chairperson of the Health Committee to devise a form of sub-collective responsibility to avert catastrophe in the Health Service. That must not be a committee for putting matters on the long finger. It must be done as a matter of urgency; the responsibility cannot be buck-passed.
I was appalled to hear the Rev Robert Coulter suggest, in his best Presbyterian minister manner, that everybody else was to blame. All Ministers are to blame; each looks after his or her own portfolio. That is where the problem begins.
Of course we are under-resourced. I support the Minister in doing what she can with limited resources. Of course Ms Hanna is correct that draconian measures must be taken to prune the excessive bureaucracy in the Health Service. From the beginning of history where bureaucracy has flourished, whether it was in Mandarin China, the Byzantine empires of the East or more latterly in Communist Russia, efficiency and delivery suffer where the citizen requires it. The detriment is in direct proportion to an expanding bureaucracy. If that problem is to be dealt with, start at the top. Prune the bureaucracy, introduce some form of sub-collective responsibility and inject a degree of urgency into a committee to tackle a problem that has been so brilliantly and so eloquently dealt with by the Members whom I have commended.

Ms Jane Morrice: We move into the second round. Members must reduce their contributions to seven minutes. That will leave eight minutes for the winding-up speeches on the motion and the amendment. The Minister will have 30 minutes to speak.

Mr Tommy Gallagher: I support the motion and the amendment. We all realise that it will take a cash injection, or a series of cash injections, to help our beleaguered Health Service.
However, if we are to make progress we must do it in a two-track system. Of course there must be more money, but there are matters unrelated to money that the Minister and her Department can deal with. It is time for action. We have been given examples of how people are suffering. The waiting lists are growing, people are being forced to suffer, to wait and, in some cases, almost beg for necessary surgery. Others, who cannot afford it, are being driven into the arms of private practice and must spend a great deal of money in order to ease their suffering.
We are all aware of the suffering of those who await heart surgery. Elderly people wait for hip replacements and fracture surgery. Even young people must wait for tonsillectomies while their health and education suffer.
Elderly people in particular are being kept in hospital for no clinical reason, at a cost of up to £900 per week. The explanation for that is that no money is available for a home help service, which could provide safety and comfort for people in their own homes. That could be provided at a cost of £100 to £150 per week. Increasingly, people who are unable to return home are being told that no money is available for placement in a residential nursing home.
Quite simply, the arithmetic does not stack up. There is something perverse about a Health Service in which, potentially, £800 per week is being spent to keep a person in hospital, while at the same time that person could be kept at home for £150 per week. We are told that that money cannot be found, and there is a lack of funds within the crazy maze of trusts that we continue to tolerate. Nobody can deny the claim that there is bed blocking. It exists and it is a direct consequence of the mess that our Health Service is in.
There is a pressing need, particularly in rural areas, for satisfactory out-of-hours medical services. The travelling distances imposed on the people in my constituency who require a general practitioner out of hours are far in excess of anywhere else in Northern Ireland. People have to make round trips of 60, 70 or 80 miles after 5.00 pm or at weekends. That is not a quality service. Steps should be taken to correct it immediately, because people in rural areas are entitled to equal treatment.
I want to refer to the Hayes report. For years, hospital staff throughout the North of Ireland have been uncertain about their future. Many staff have told me — and perhaps other Members have also been informed — that the Hayes review was another unnecessary review. However, it was undertaken after devolution, and we all accepted that we could put up with it. We now have the report from the independent, expert and representative body, but it has been put aside. We are told that it will not be acted on until some time in the future. We owe the dedicated medical and ancillary hospital staff in our hospitals some certainty about their future. We should not wait any longer, and we should act on the recommendations of the Hayes report.
Common sense, immediate decisions and money are needed to sort out the growing crisis. People are fed up with reviews and consultations; it is time to end the prevarication. The community needs actions and decisions. I ask the Minister to tackle the issues that I have outlined. Most importantly, none of us should lose sight of the fact that we are talking about the health and well-being of our families, our neighbours and the community. We are not talking about customers, numbers or lists. We are talking about human beings who deserve all the care and attention that society can give to alleviate their suffering.

Mr Roy Beggs: I rise to support the motion.
Everyone must accept that the National Health Service is currently in crisis. The realities of the community health and social services sector and of our hospitals cannot be disputed.
During the course of my constituency work I have come across many issues of concern. There is a huge question mark over what the Department of Health, Social Services and Public Safety actually does in its oversight role of boards and trusts. Why did it take 18 months of lobbying before the Department accepted the views of the community, politicians and trusts that there was a shortage of places for speech therapy training? Why has this only recently been increased from 20 to 30? Sadly it will be a further three or four years before these students qualify, take up posts and address this need. I welcome the fact that this is now being done, but why did it take so long? Manpower planning should have been a basic part of the Department’s role from the start.
Nursing training is another area where, again, there were deficiencies. Over a decade ago Northern Ireland exported nurses. The numbers in training were then virtually halved. Everyone is aware of the shortage of nurses, but only recently have the numbers been gradually increased. The result is that we are now paying extra for agency nursing. The Department needs to look collectively with the boards and trusts at ways of introducing additional flexibility and retaining more of the existing nursing staff.
The inappropriateness of the current relationship between the system of boards and trust has been brought home to me, again, through constituency cases. I have been told by women whose husbands have been in hospital that they wanted to come home to be closer to their families but were unable to do so. This is bed blocking. In answer to questions in the Assembly, the Minister advised me that, as I suspected, large numbers of people are blocking beds in acute hospitals. On 31 August 2001, 12% of the beds in United Hospitals Health and Social Services Trust were blocked. Many patients who wished to return home were unable to do so, as the funds were not following the patient. That is what should be happening, rather than giving block funding to certain areas and not having flexibility. It costs twice as much, perhaps even three times as much, for an acute sector bed compared to a bed in the community.
As someone who lobbied for additional funds for community health and social services, I was particularly pleased that in the Budget which we have just passed, 1,000 additional healthcare packages are to be provided in the subsequent year. However, there is a need now, and we must all watch the situation carefully. There is a huge Department, four boards and 19 trusts. Apart from the inherent inefficiency, that is also delivering inequality.
When I asked the question on the average expenditure per person in different health and community trusts, huge variance was exposed. In the South and East Belfast Trust it is up to £540 per person; in Down Lisburn Trust it is £329 per person; and in my area Homefirst Community Trust spends £369 per person. With that difference in funding comes huge inequalities and variation in the delivery of services.

Mr Duncan Dalton: From what my Colleague and other Members have said, it is clear that the Health Service as it stands in the Province at the moment is an absolute shambles. It is clear that the Minister is making no effort whatsoever and making no progress in reforming it — and fundamental reform is what is needed. I urge both Sinn Féin and the Minister to get out of office, find someone who can do the job and let us see the Health Service that Northern Ireland deserves.

Mr Roy Beggs: I share much of the frustration expressed. There is a need for inequality to be addressed. The Minister has to be aware of what this inequality is delivering. In my area, which had a £1·6 million deficit during the first six months of this financial year, services are being cut and waiting lists extended. Recently I was contacted by a family who care for a disabled relative. They had organised to move from a house to a bungalow. However, when they went to move, they found that, despite previous co-ordination, no home help was available initially.
That severely disabled man might have had to go into a nursing home, for want of home-help assistance for one hour a day. The proper care in the community was not being provided, and additional expenses to the public purse could have been incurred.
Occupational therapy is another area of concern. When I chased up the case of a constituent, I was told that priority cases are taking some six months to be seen by occupational therapists. It is not the therapists’ fault — they have tried to prioritise and to ensure that the important cases are seen quickly. Because of the lack of resources, morale within the service is going down. The constituent whom I mentioned was in need of a wheelchair, but in October there was no money available in the Homefirst Community Health and Social Services Trust area to provide basic wheelchairs. We are not talking about rocket science — money has to be made available for basic services.
I mentioned the issue of inequalities earlier. The need for basic facilities for the disabled is not even being addressed. I know of another disabled person who needed an occupational therapy assessment to have a ramp installed at his house to give him the basic human right of access to and from his home. He is living alone, and luckily he has a very good neighbour who has been helping him. That occupational therapy assessment took an undue length of time.
Basic services in the community must be provided. Like many people, I am concerned about the amount of money that has been put into the Health Service and the fact that there is little in the way of reforms to show how that money is being spent. The general public want more money to be invested in the Health Service, and that has rightly happened, but we need to have confidence that the money is being well spent. We need transparency, so that we know what the money has been spent on, and that it is providing value for money.
I understand, with concern, that the Northern Ireland Audit Office has not been able to approve some of the accounts. Why not? Surely we ought to know where the money is going and what it is being spent on. We must get value for the patients and improve the service to our constituents.

Mr Jim Shannon: Yinst mair A maun speik up for the Depairtment o Halth, Social Services an Public Sauftie, for its Meinister disnae seem able for it. This maitter mebbe isnae o onie interest til the Meinister, sin it’s nocht adae wi speikin the Erse or wi Erse cultur; at the hinner-end it’s relate ti this kintra an hauldin its fowk — comprehendin thae fowk versant in Erse — haill an fere.
Once again I must speak up for the Department of Health, Social Services and Public Safety, as its Minister seems incapable of doing so. This subject may be of no interest to the Minister as it is nothing to do with speaking Irish or the Irish culture — it is, after all, relating only to this country and keeping its people, including those who speak Irish fluently, alive and well.
I want to highlight some issues in relation to care in the community. Some £13 million was set aside for care in the community services, and even that amount is unlikely to result in a break-even situation, because the Government are giving money to the Health Service and to that particular area. The last time we spoke on this matter, in relation solely to the Ulster Community and Hospitals Health and Social Services Trust, at least £20 million was needed to address care in the community. The sum of £13 million across the Province is a very paltry sum in comparison — and it is spread across 19 trusts and 4 health boards. It is just over 4% of the sum awarded to England and Wales.
The amount of money needed to cover the community care bill is staggering. The Strangford area has seen less money and time spent on its elderly and disabled people than has been the case in many other places. It is incredible that, in the twenty-first century, people are still living in cold houses and will have to continue to do so for the immediate future, because the hospitals still cannot afford to provide adequate cover or support to ensure a comfortable life for all.
The lack of adequate funding has stretched resources for the whole of the National Health Service. Elderly or disabled patients are not being allowed home until adequate care facilities are available. There are currently no available community care places, which means that beds are being taken up by patients who could be cared for at home. That has the knock-on effect of increasing the time that people spend on waiting lists and increasing the numbers on those lists. In the Ulster Community and Hospitals Health and Social Services Trust area, 50 patients in beds could be released if there were enough money to provide community care. That means that reasonably well people who just need aftercare are blocking 50 beds.
The same scenario is being repeated in many areas of the Province.
Funding has been sporadic and inadequate. It is hard for staff to see a speedy solution to the problem. Last year, the Ulster Community and Hospitals Health and Social Services Trust received funding for nine additional complex care packages. However, so far this year 60 additional complex care cases needed help, and they cannot be looked after. There is a great shortfall. Thirteen million pounds will help a little, but not enough.
We can petition the Government for funding, but they are too slow to react. The subsequent snowballing is a problem in our own areas. It does not help that the Government do not see the National Health Service as an entire problem. All areas in the trusts are affected, although members of the public get angry only about the problems that affect them at any given time.
The call for more money is not a request or an item on a wish list; it is a demand and a need. We do not want to see money being put into the bottomless pit of the Health Service. We want the money to go directly to the people who need it most. My Colleague Paul Berry talked about the pressures on doctors and the help that they need. They are short of funding.
The underfunding and mismanagement of the Health Service has occurred under the present Minister. It is not due to Margaret Thatcher, as Mr McCarthy said. What has happened in the three years that the Minister has been in control? Her insistence on spending money on the Irish language and culture prevents some of those most in need from getting help. The Minister has given the go-ahead for pay rises for chief executives. How far behind the times is she? Has she not been listening to the nurses and doctors telling her that chief executives’ pay has been eating into hospital budgets?
Administration soaks up money and takes funding away from those who need it most. Some chief executives earn 10 times more than nurses do, and they can double their salaries with bonuses, something which other Members have referred to. Would it not be more sensible to invest the money in nurses, doctors and equipment rather than in chief executives who sit in offices and direct others?
The funding is not sufficient to cover the problems with community care in one trust, let alone all the trusts in the Province. The country deserves more than the paltry £13 million that has been set aside for the care of the elderly and the disabled. The money will alleviate the problems for community carers, but not for many other people. Even then, it will only do so for a short time. It would be better if the Minister examined the efficiency of the trusts, the need for staffing and equipment and particularly the need for adequate funding.
Ms Hanna’s motion is worthy of support, and I can go along with it. I want to mention an incident that occurred just over two years ago, when Northern Ireland suffered a serious flu epidemic. The nurses were also suffering, and the beleaguered staff were working on emergency rotas. Some nurses were working 12-to-14-hour shifts. The elderly and the young were not the only people affected, and the nurses were so run-down that they were in danger of being the next target for the debilitating bug. In their wisdom, the executives of the trust thought that it would be a brilliant idea to employ agency staff. They were mindful that they had to restrict themselves to their budget, but they paid the agency nurses almost twice the hourly rate of the regular nursing staff. Members can imagine the nurses’ reaction when they found out. Unfortunately, they could not go on strike, because of their oath to care for the sick. The chief executives did not reimburse the nurses who struggled through the staffing crisis, nor did they show appreciation verbally. It must be soul-destroying to work for a boss who thinks only about his bonus while his staff are in the firing line.
We have the same problem today. We are talking about community care, while the chief executive still gets his money. It is crucial that money is spent where it is most needed. It is unfair and unreal to suggest that the money that goes into the Health Service should end up in administration and stuck in the system. Give it to the people who need it. The Minister has failed miserably to do that in her three years in power. If she were in power for 33 years, she still would not address the issues to ensure that those who need care receive it.

Ms Mary Nelis: Go raibh maith agat, a LeasCheann Comhairle. The motion concerns the crisis in the Health Service, and it urges the Minister to take urgent action to tackle that crisis. No one would disagree with the sentiments of the motion, least of all the Minister. During her short term in office she has endeavoured to deal with the crisis that has existed for at least 10 years and which was 18 years in the making.
However, the motion is not really about concern for the health of the people. It is about attacking Bairbre de Brún. It is party politicking of the worst kind. It is political point scoring on the back of the sick and the dying. Assembly Members should exercise our responsibility collectively and examine how we, as politicians, can address the issue of the Health Service.

Mr Danny Kennedy: Will the Member give way?

Ms Mary Nelis: I will not.

Ms Jane Morrice: Order. The Member is entitled to refuse to give way.

Ms Mary Nelis: The SDLP and the DUP resort to cheap attacks on the Minister for media consumption. Duncan Shipley-Dalton must be making a bid for the seat that he lost. When the SDLP had the choice of ministerial briefs, it chose to back off from health. The SDLP — [Interruption].

Ms Jane Morrice: Order.

Ms Mary Nelis: The SDLP knew that Bairbre de Brún had taken a poisoned chalice. So too did those other vociferous critics — those parties that did not have the guts to take on that brief.
The motion talks about a "current crisis". There is a historical crisis in the National Health Service created by 18 years of Thatcher and Tory undermining.

Mr Danny Kennedy: Will the Member give way?

Ms Mary Nelis: I will not.
They did not subscribe to the National Health Service. That was followed by six years of Labour mismanagement and refusal to recognise in the Barnett formula the special circumstances of the North of Ireland.
There is a crisis in the health service in the UK and in the Republic of Ireland. We have known about that crisis since the time of direct rule and Westminster decision-making that destroyed the service. While the Tories were putting the nails in the coffin of the National Health Service that resulted in this crisis, the twelve apostles — the MPs from the Six Counties sitting at Westminster — presided over the wake.

Mr Danny Kennedy: Will the Member give way?

Ms Mary Nelis: I will not give way.
The crisis in the Health Service is what the Assembly has inherited, and it must be put right. There are no quick fixes. Tony Blair is in the same position as Bairbre de Brún. During his election campaign he talked about 10 days to save the National Health Service. He is now talking about 10 years. He knows, and this Assembly knows, that the Health Service can work and that it does work. However, to work it needs commitment and resources. It needs a commitment from Members to believe that, collectively, politicians can deliver a service that people can rely on.
We acknowledge the additional finance provided by Mark Durkan. However, it is £50 million short of what the Minister requires. Last year there was a £700 million underspend in health in England. Mark Durkan should bid for part of that. We do not need to rehearse the Derek Wanless report into the undermining of the Health Service. We have watched over the years as managers and chief executives have been replaced by trusts, boards, and innumerable quangos. The stethoscope was replaced by the briefcase, and patients suddenly became clients.
We do not need brain surgery to tell us the obvious. If you employ fewer nurses and doctors; if you invest less on equipment and technology; if you create a system of private and public fundholding, you will get what Northern Ireland now has — an inferior Health Service on a starvation diet. We know about the waiting lists, the winter pressures, the breast cancer survival rates, and the beds in corridors. These things did not happen because Bairbre de Brún became Minister of Health. They have been there for years. [Interruption].

Ms Jane Morrice: Order. I will have order in this House.

Ms Mary Nelis: We know that if you need a hip replacement, you will have to live in pain for years. The mother of the Minister of Education, Martin McGuinness, was exported to Scotland for her operation after spending years on a waiting list. That was long before Bairbre de Brún became Minister of Health.

Ms Jane Morrice: Order.

Ms Mary Nelis: During 30 years of conflict, additional pressures were put on our Health Service. However, far from being given additional resources to cope with the war, Health Service finances were siphoned off to pay for the British war machine, prisons, police, quangos, and endless bureaucrats.

Mr Danny Kennedy: Will the Member give way?

Ms Mary Nelis: For the fourth time, I will not give way.
As if that was not bad enough, the move towards privatisation by the back door, which the Tories began and New Labour carried on, has starved the Health Service of money and prevented service delivery. We all know that privatisation of catering and cleaning services in hospitals was a disaster for workers, patients and medical staff.
The basic cause of the failure in the Health Service is inadequate funding. The Minister recognises that, and she recognises that a cultural change is needed. We must establish a patient-led service. The days of fat cat managers lining their pockets while doctors and nurses struggle to survive on a fraction of the salaries that are paid to some chief executives are gone forever — [Interruption].

Ms Jane Morrice: Order.

Ms Mary Nelis: Those days are gone because of what Bairbre de Brún is doing. The Minister has begun to address the problems of the fundamentally flawed, under- resourced and badly managed National Health Service in the Six Counties. She should be given every support and resource necessary. It is a test — not for her, but for the Executive and for us as elected representatives. It is our collective responsibility. We must do better. Go raibh maith agat.

Dr Alasdair McDonnell: This debate is not an opportunity to attack or blame the Minister, the Executive or anybody else. The problems in the Health Service are everybody’s problems. We are all responsible if the service is not working.
The Health Service badly needs a major injection of positive, creative management. The service must be proactively managed, with greater vision, some stability and some hope. In 25 years as a GP, I have never known nursing, medical and other staff to be as despairing or depressed. They are not sure what tomorrow will bring and what they will face. The only certainty is that they are faced with muddle, confusion and a lack of access to the necessary secondary care and service.
The people who work in the Health Service can make a difference, but they need to feel that they are encouraged and supported. That goes beyond rhetoric. They need some vision and some sense that their commitment will be rewarded. They must be given the opportunity to show local leadership, and they must be given credit when that local service is delivered.
The merry-go-round management in the bureaucracy of the Health Service must end. Under the guise of consultation, there are continual meetings and reviews, but no real decisions are taken. That is especially frustrating at the middle and lower levels of the Health Service, where it can take years to reach a simple decision. Management at trust and board level has become little more than a grandiose exercise in passing the parcel. Things go round and round like the revolving door of a large supermarket.
Frustration is immense at the primary care end of the service. Hospital waiting lists are longer than ever. Although some people working in hospitals may not agree, many in the medical profession feel that efficiency in some aspects of the hospital service is less than optimum. I am not referring to the accident and emergency departments; I had every sympathy with Dr Liz Dowey in Belfast City Hospital when she screamed — almost in despair — for help and support a week ago.
I am concerned about the lack of a proper surgical service. About six weeks ago, GPs received a letter from the neurosurgery department of the Royal Victoria Hospital saying that while they would struggle on with head injuries and such, they could no longer operate on brain tumours. I understand that at that stage some people with serious life-threatening brain tumours were sent home without having had an operation. The same situation exists in cardiac and orthopaedic surgery.
Those are the regional services, where people have no choice but to wait. There is only one service for those specialities in Northern Ireland. In some of the simpler services things are different; there is a scattering of provision across various major hospitals. If a service is not available in one, it may be worthwhile applying to another. When the regional services become clogged up, however, everything clogs up.
There is a critical lack of nursing and technical support staff in many surgical sub-specialities. While there may be surgeons, anaesthetists and all the people required to undertake surgery, they do not have the nursing and support staff to look after patients in intensive care following surgery. That creates major bottlenecks and obstacles to good healthcare and good practice.
On the other hand, as other Members have said, in many cases there is a shortage of medical staff. I was told by a friend that in the Northern Health and Social Services Board area there is only one rheumatologist to deal with rheumatoid arthritis. That person runs from pillar to post to provide a skeleton service. There is a need to examine such shortfalls.
Primary care must be freed up and allowed to get on with what it does best. GPs and community nurses have built up years of useful experience in dealing with people, but the problem is that many of my GP colleagues spend up to 25% of their time lobbying hospitals and trying to beg, coax and cajole their way past the waiting lists for those who are critically ill. Much of that time is taken up by unnecessary consultations with people who plead to have their appointments brought forward because they are "going down the hill" and want something done for them before they die.
Perhaps 85% to 90% of National Health Service care occurs in primary care. The essence of the solution to much of our problem could be dealt with there. I commend the Minister and the Department of Health, Social Services and Public Safety. The recently announced initiative on winter care, the effort to unlock some of the potential in primary care, is very welcome. It could be better funded, but it is a start and a step in the right direction.
In the limited time available, I want to mention psychiatric care.

Ms Jane Morrice: The Member’s time is up.

Dr Alasdair McDonnell: Psychiatric care has been forgotten in the plethora of activity. If you will indulge me, Madam Deputy Speaker, I want very briefly to appeal —

Ms Jane Morrice: I am afraid that the Member gets only seven minutes. I must ask him to sit down.

Dr Alasdair McDonnell: I want to appeal for the elimination of some of the bureaucracy. I hope that we can get rid of some of the boards and amalgamate some of the trusts.

Ms Jane Morrice: Order. The Member’s time is up.

Mr Jim Wilson: I will attempt to speak in — I hope — a good, sound south Antrim dialect. I hope that Members will not need earmuffs either to block it out or to work it out.

Mr Alan McFarland: Not Ulster Scots?

Mr Jim Wilson: I speak Ulster Scots all the time. Earlier this week I addressed a group of senior citizens, and last night I addressed a group of my constituents who were touring the Building. I advised both groups to try not to be sick this winter. Those are not the words of someone who is trying to catch a headline or be alarmist. I believe that I gave them sound advice.
My constituency office in South Antrim receives calls on a variety of topics, but recently health issues have outnumbered all others. Daily, distressed constituents call for assistance. In the last few weeks alone, issues have included waiting lists for psychiatric treatment and the problem of no emergency beds for psychiatric care. Patients wait for days to have broken bones set. Elderly patients are left in bed at home unwashed and uncertain about when their care workers will call. People are concerned about the inconsistency and unreliability of health services. Patients are being released prematurely from hospital following surgery with no arrangements made for their convalescence. Elderly and disabled patients are discharged from hospital with no satisfactory support at home. Families with severely disabled relatives are left to struggle alone, and there are reports — and I emphasise the term "reports" because I have no first-hand proof — of patients lying in hospital wards where hygiene standards are not as they should be.
At a recent meeting with representatives of the Northern Health and Social Services Board, colleagues from my constituency and I were alerted to the serious problems that lie ahead. We heard of the sheer frustration, despondency and poor morale that is seeping through the entire staff structure at administrative and professional level. That can have only a detrimental effect on the good work that they strive to do and is expected from them. We were told of many schemes that they would like to introduce to benefit patients, but cannot because of a lack of funds. The Minister should note that extra money coming into the system now will support only the status quo. It will not support new proposals for better care — it is needed to balance the books.
We hear day and daily about the lack of accountability and, therefore, responsibility that permeates the system. The Department gives money to the boards; the boards give money to the trusts; and along the way, as my Colleague Robert Coulter and others have said, the audit trail just leads to a bottomless pit. The audit trail has been described by some as leading to a big, black hole. Those are not my words; it is what I am told by members of the Committee for Health, Social Services and Public Safety and others. When other Committees carry out an audit, recipients of money can be identified — but not so with the Health Service.
The underfunding of the Administration during the years of direct rule means that if we are to achieve the standards enjoyed elsewhere in Europe, we must play catch-up in nearly every aspect of life. The funding of the Health Service has always been a cause for concern, but I fear that this crisis means that the Health Service can be described as having broken down.
I fear that it is the elderly, those most in need, who are being treated most abysmally. Those people in the early years of their life did not enjoy some of the modern services and appliances that we who were born in the post-war years have come to take for granted. Many of those people worked hard to save for their old age, and society has let them down and continues to do so. They deserve better.
As might have been suggested by Mr John Kelly, I am not playing games — but I do not want anyone to play games with my health. I support the motion.

Mr Oliver Gibson: We have heard many adequate and eloquent descriptions of the current crisis in the Health Service. About eight weeks ago, I had a bout of puritanical frustration. I discovered a 17-stone weight of documents in my office that had been produced on the Health Service since 1998. There were several reports, including the Hindel and Pantell Reports, quality impact assessments, first, second and third editions of consultation documents, healthy-eating documents, and healthy-living documents. All that I could think of was the state of health of a patient who had just left a doctor’s surgery and her hope to get a simple operation.
What I moved out of my office represented the devastation of hectares of trees; a waiting list that was growing by the furlong, and millions of pounds that were wasted because the information had to be written, printed, produced and circulated. I appeal to the Department of Health, Social Services and Public Safety to stop producing expectations that cannot be delivered. This also applies to the recent Burns Report. We have had health charters, including the Patients’ Charter, and various aspirations as to the delivery of services we could expect have been stated. However, they have been like many political manifestos — not surviving even past election day.
We have suffered from gross underfunding for over 30 years. Last night we read about the state of our transport system. People who live in the west of the Province could tell you about the desperate state of our road infrastructure. The Health Service has also experienced 30 years of underfunding. We quickly forget that we suffered 30 years of devastation caused by the Provisional IRA.

Mr Danny Kennedy: To help amplify the point, will the Member join me in condemning the actions of Sinn Féin Youth, which is sponsored by the political party of the Minister of Health, Social Services and Public Safety, whose actions were —[Interruption].

Ms Jane Morrice: Order. The Member will resume his seat. This is not in line with the debate.

Mr Duncan Dalton: On a point of order, Madam Deputy Speaker. How can a comment on health expenditure, and the reason for that expenditure, not be relevant to the debate?

Ms Jane Morrice: I have ruled that the Member’s comment was not in keeping with the context of the motion.

Mr Danny Kennedy: On a point of order, Madam Deputy Speaker. It was clear from my intervention, which the Member for West Tyrone allowed, that I understood him to be making a point about the expenditure incurred by the Health Service due to the war of terrorism waged by paramilitaries. This war placed a significant burden on the health budget, and I was simply bringing the House up to date on the matter.

Ms Jane Morrice: Order. I will consult Hansard and respond to the Member.

Mr Oliver Gibson: We have suffered 30 years of underfunding. Although we have committed 40% of our Budget to health, there is not an opportunity in the short term to make up for the 30 years of havoc and wrecking caused by the Provisional IRA.
We must honestly examine how that 40% can be constructively utilised to deliver the best possible service. Members have eloquently described the budget trails and the administration of community care. However, Mr Robert McCartney was the only Member to put a constructive proposition to the Assembly. On the radio this morning, I heard GPs, consultants and employees in every aspect of primary care talk about this crisis and demand immediate action. In a crisis, we should pull out the stops and introduce emergency management of our 40% of the Budget to ensure that it is delivered in the most effective way.
The designer suits can no longer put a gloss on such evident failure. We must get down to the job of managing that 40% of the Budget in order to deliver, as far as possible, on the Minister’s mission statement. The matter is much too serious for any political gimmick. I do not like the idea of one party jockeying against another. My constituents deserve the best healthcare possible, and other Members will wish the same care for their constituents. We have not examined how we will manage the crisis, nor have we heard a response to our questions. The Minister’s task is to work out how we can manage the crisis; that responsibility falls not only to the Minister, but to every other Member.
(Mr Speaker in the Chair)

Ms Bairbre de Brún: Go raibh maith agat, a Cheann Comhairle. Tá mé buíoch de Carmel Hanna as an rún tábhachtach seo a chur síos ar chlár.
Tig an díospóireacht seo i ndiaidh ár ndíospóireachtaí ar an Bhuiséad an tseachtain seo caite, agus mar sin taispeánann sí a dháiríre atá an Tionól faoi na géarfhadhbanna atá os comhair ár seirbhísí sláinte; seirbhísí atá an-tábhachtach go deo ag an phobal uilig.
D’éist mé go cúramach agus le suim mhór leis na pointí a luadh. Aontaím le cuid mhaith de na tuairimí a nochtadh agus is maith liom go n-aithnítear go leathan go bhfuil brúnna suntasacha ar ár seirbhísí sláinte agus sóisialta. San am a chuaigh thart ba séasúrtha iad cuid mhaith de na brúnna a tugadh chun solais le linn na díospóireachta; ba bhrúnna iad nár tháinig ach le linn bhuaic-amanna éilimh i míonna an gheimhridh. Anois, áfach, ó tá éileamh ag méadú de shíor agus ó tá seirbhísí ag feidhmiú ar a lánacmhainn, ach sa bheag, bíonn na brúnna seo ann ó cheann go ceann na bliana.
I am grateful to Ms Hanna for tabling this important motion. Following our debate on the Budget, today’s debate underlines the seriousness with which the Assembly views the real problems facing the Health Service. I welcome Members’ interest in the services, which are crucially important to the community.
I also welcome the widespread recognition of the significant pressures on our health and social services. In the past, many of these pressures were seasonal; they arose only during peaks of demand in winter months. Now, as Mr Watson pointed out, this is a year-round phenomenon, as demands grow and services work almost to capacity.
More is being demanded of our health and social services. The number of patients being treated has risen by no less than 10% in the past five years, and the number of community care packages has risen by 27% in the same period. During the past year alone, medical activity in the Eastern Board area has increased by nearly 10%. We must add this considerable rise in numbers of people waiting for treatment to the stark rise in the numbers being treated in order to appreciate fully the scale of the increase in demand.
In the face of this rise in demand, hospital staff and community providers are tireless and dedicated in their work. We owe much to the commitment and dedication of the staff who provide the necessary skilled care and treatment, often in less than ideal circumstances. Despite the efforts of staff, it is simply impossible for any service routinely to absorb increases of that magnitude without pain. The recent additions to the Budget are welcome, but they do not allow us to match the extra funding that the NHS in England is getting at present. Matching that funding would require many millions of pounds. The NHS sets many of our costs drivers — our levels of pay and the cost of drugs are decided there. We cope here; we suffer costs that are beyond our control without the comparable funding required to meet them.
Bob Coulter, Carmel Hanna and Paul Berry raised the matter of the regional strategy. Planned, concerted work is being done to develop a soundly based strategy, and I have been carefully constructing the building blocks for the strategy by concentrating, first and foremost, on the key areas that must underpin any new direction.
These include prevention and health promotion; primary care development; the review of community care; the reorganisation of acute hospital services; establishing clear standards of quality and professional regulation; workforce planning; and securing a sound financial base. In doing this I have been conscious of the importance of interaction with the public, with the staff of the health and personnel social services and with service users. I have ensured that they have a say in developing my approach and, as I bring all the building blocks together in an overall regional strategy, I shall ensure that this important element of public consultation continues.
I welcome the wider debate here and elsewhere about the level of funding needed for health and social care. These services and our willingness to support those who are sick and vulnerable define our society. This is a challenge that the Assembly and society in general cannot walk away from — it is a collective responsibility in which we must all play our part and in which we must all work together. Mark Durkan’s announcement last week is evidence that the Executive and the Assembly are ready to rise to this challenge. Our services have paid a price for years of underfunding, and I welcome the fact that many Members recognised that in their contributions. That past underfunding weakened our services and brought them to the brink. This historic neglect must be rectified; only now are we beginning to do that.
The additional resources give a positive signal to the Health Service. Clearly, they are not sufficient to turn the situation around, but they will allow us to help services that need urgent investment to maintain their effectiveness and to continue to meet growing demand. They will allow for some carefully targeted service development. In my time as Minister I have also sought to build the effectiveness of our services and to focus on key problems. Much has already been achieved, even under severe financial constraints. We have increased critical care provision significantly. By March 2002 we shall have 33 more intensive-care and high-dependency beds than I inherited as Minister.
There are now 100 more training places for nurses and extra residential childcare places. We have three permanent MRI scanners in place, and we have secured funding for three more. The number of people waiting for MRI scans has been reduced. While targeted improvements, such as those I have itemised, are being put in place, we are working to sharpen the effectiveness and the efficiency of the service. For example, the service now has a new performance management system to improve planning and accountability. Winter planning has been improved, and by March 2003 efficiency savings of £12 million will have been reinvested in services.
I recognise Members’ concerns about winter planning, given the pressures on services. Boards and trusts have planned more comprehensively than ever before for winter and its associated pressures, and as in last winter, more primary care services and more community care support will be available. We are completing a targeted programme of flu immunisation, and we are building on the success of the 2000-02 campaign; more beds will be available at peak times and for emergency admissions, and there will be more specialist beds in critical care areas. Later this month I shall meet the chairpersons of the health and social services boards for a final review of arrangements for winter; arrangements for working together in integrated planning that have been going on all year at official level.
This is prudent, orchestrated planning to relieve the expected pressures of winter. The funding that was made available in the Budget and in-year additions will help us to make some extra provision for those anticipated pressures. However, services that are running almost at peak capacity for most of the year do not have the spare capacity to react instantly to sudden surges in activity. We must build that capacity and recruit and put in place the additional staff and facilities to cope with higher levels of demand. I have already taken measures to increase specialist nursing and medical staff; these measures may take time to yield benefits, but they are an important investment for the future.
In the interim, work continues on tackling nursing needs during the winter. The best and most effective way of guaranteeing that peak pressures can be met effectively is by ensuring that a properly resourced service is in place. That is the best — indeed the only — lasting solution to winter pressures.
The Department has embarked on a major initiative to improve workforce planning mechanisms, and the work should be completed during the next year. The document ‘Best Practice, Best Care’, which recently completed consultation, dealt with setting, monitoring and enforcing standards. Decisions on the way forward will be taken soon. Consultation is necessary, and the documents that some Members have referred to are essential for progress.
I shall return to the matter of financial accountability. We keep a close track of money, and it does have a real effect on the quality and volume of care and treatment.
The Department’s role has changed from regulating an internal market, particularly under the British Conservative Government, to one of direct management under the re-established local Executive. Therefore we have implemented significant changes in how we manage our resources. We have much tighter control over the allocation of resources. For 2001-02 that can be traced from the Programme for Government through the public service agreement into the priorities for action, which set out the key priorities for the service. Boards are required to use that new approach in their service investment plans to describe how they intend to deploy their additional resources; similarly, trusts, in their service delivery plans, must set out how they will deliver my agenda. Regular progress meetings with the boards enable us to keep track of how money is spent and of the outcomes of that spending.
We shall take the same rigorous approach to financial management in 2002-03.
The Comptroller and Auditor General does have audit authority over the Department of Health, Social Services and Public Safety, just as with any other Department. While he does not have direct audit process powers over the health and social services trusts, those are subject to the scrutiny of the Health Service auditors.
I accept and absolutely agree with Members that a long-term approach to the issue of waiting lists is needed. In fact, our approach, as I set out in our framework for action last year, is based on a consistent long-term approach. I made some funding recurrent that had been non-recurrent in the past in order to have that consistent approach. We need long-term action, supported by the necessary resources and service capacity, to provide levels of service that will meet need. In the South and in England, where we have seen action, it has been not only on waiting lists but also on building the capacity of the service. In dealing with capacity generally, the only cure is more resources.
To aid efficiency, a significant programme of work is under way to improve the flow of patients through the system. That includes reducing the number of people who fail to keep their appointments and putting in place alternatives to hospital admission, such as physiotherapists in the community treating patients with back pain. It also includes ensuring that theatres are operating at maximum capacity and validating waiting lists to ensure that they are accurate.
The service has taken a number of initiatives, and I have outlined that several times during debates in the House. Despite the problems, the Health Service has continued to treat similar numbers of patients as in previous years and has made efficiency gains by, for example, treating more patients as day cases.
A number of measures have been taken to help alleviate the current difficulties with regard to fractures. These include the provision of additional theatre lists at the Royal Victoria Hospital, the Ulster Hospital and Musgrave Park Hospital, and the use of spare capacity at the Duke of Connaught unit on the Musgrave Park Hospital site. The Department continues to monitor the service to ensure that emerging difficulties are effectively addressed.
Joe Hendron asked about the cardiac surgery review. Implementation of some recommendations relating to changes in clinical practice is already in hand. Some of the extra resources allocated for next year will support additional cardiac surgery procedures. Implementation of some of the other recommendations will depend on the outcome of the consultation process and the availability of resources in 2002-03 and beyond.
However, my Department has already allocated additional funding for specialist nurse training posts in cardiac intensive care to support the existing staff and allow additional nurses to receive specialised training. Of the 13 additional nurses going through specialised training in the cardiac surgical intensive care unit, 12 have remained in post. A further four specialist nurses are currently going through. A consultant anaesthetist is now also present in the unit during working hours. A significant number of the protocols recommended by the two reviews have also been adopted.
Dr Hendron also asked about the ending of GP fundholding and a "seamless transition." At the beginning of the year, when we had a debate about ending GP fundholding, it was pointed out that the money currently being used to run the GP fundholding scheme and the commissioning pilots will be redeployed to meet the cost of the new arrangements. That is on top of additional resources that we made available to boards to allow them greater flexibility to enhance the quality and quantity of primary care services.
While every effort will be made to ensure that there is a smooth transition to new arrangements, it is clear that the money currently used to run the GP fundholding scheme will be redeployed. It will be available, once GP fundholding has ended, to meet the cost of the new arrangements. We are now making firm plans to end the GP fundholding scheme from 1 April 2002. That will allow us to move forward from there. As Members will know, work is already under way to set up the local health and social care groups.
I share Prof McWilliams’s expectation that the needs and effectiveness study will illustrate the extent of the pressures on the service. The study will also show that the service performs effectively in the present circumstances.
Bob Coulter and other Members asked about structures and administration, and those aspects will need to be looked at in the context of the Executive’s intention to review public administration, and of the recommendations and proposals made in the acute hospitals review. The Executive will decide if changes should go ahead. However, we should not fool ourselves that that will somehow solve the funding problems of the service, because it will not.
Carmel Hanna asked about the compatibility of information systems. The implementation of a project to introduce a unique identifier for patients across all areas of Health and Personal Social Services is due to begin early in 2002, as funding for that has now been secured. That will ensure that ICT systems throughout Health and Personal Social Services and in GP practices include the new identifier as part of their patient records. That is a first and essential step towards the reliable sharing of electronic patient data and the exploitation of modern ICT services to communicate that information. The recent Executive programme funds announcement also included funding for further bids that we have made to allow us to further improve ICT facilities in the service.
On 11 October, I announced a new pay and grading system, in response to concerns, which I have long expressed, about the award of substantial pay rises to senior executives. That practice was derived from the old internal market, which gave trusts the freedom to develop their own pay schemes and to make their own pay awards. All new appointments will be made on the basis of the new scheme. Existing staff will have the legal right to retain their current contracts, but the Department will work with the service and employees to encourage staff to move on to the new contract and to ensure that the service is working with employees on the question of how to move forward.
Joe Hendron and Alasdair McDonnell raised a question about neurosurgery and the letter to GPs from the neurosurgery department at the Royal Victoria Hospital. The trust has told me that emergency head injuries continue to receive immediate attention. To help to overcome some of the difficulties that exist, the trust has increased the number of theatre sessions and has employed a staff grade doctor. That has enabled it to provide three extra neurosurgery sessions. It hopes that nurses will soon be ready to take up posts in this specialised area, enabling the neurosurgical unit to return to its complement of 40 beds early next month.
I recognise the difficulty in recruiting care workers, particularly to posts that involve unsociable hours. I appreciate that money is an issue, and that there are other questions. I am aware of the need for funding for the residential nursing home sector, and that will be among the matters that I will examine in the weeks to come, when I decide my detailed allocations for the forthcoming financial year.
Tommy Gallagher said that it was cheaper to keep people at home, rather than in hospital, and I recognise that. The funding allocated for 1,000 additional packages, and the additional £8 million provided this year, will help trusts to address this issue. The 1,000 extra community care packages to be provided next year have been made in recognition of those difficulties. The draft Budget, as Mr Gallagher knows, did not allow for development. We now have the ability to make some developments in certain areas. In the interim, the cost of a hospital bed is comprised mainly of staff costs. Those are fixed costs, which cannot be freed up readily for redistribution to the community.
Where we can put extra money into the community to free that up, we will do so. Money, of course, is not the only consideration. Statutory and independent sectors compete with large supermarkets, call centres and others in a decreasing pool of available staff. That has also created some difficulties.
On the acute hospitals review group report, the numerous comments made during the consultation period are now being analysed. Following consideration of the outcome of the public consultation process, and discussion with Executive Colleagues, proposals on the way forward can be put out for consultation. I assure Tommy Gallagher that I hope to be in a position to announce decisions in the course of 2002.
Roy Beggs raised the question of the variation in the funding of community trusts. Community trust spending varies because of age, need and rurality. Those factors vary from trust to trust. The figures available may well include services to populations beyond the immediate catchment area of the trusts concerned. Some trusts have a regional function, and Muckamore Abbey Hospital, for example, falls into that category in relation to the North and West Belfast Health and Social Services Trust.
I share the desire of Members to put in place high quality and responsive services that are available to support those who need them, when they need them.

Mr Speaker: Order. If Members wish to have a conversation, they should use the Lobbies.

Ms Bairbre de Brún: I share Members’ concerns that waiting lists for hospital treatment are so high. I share their concerns that so many vulnerable people are waiting in the community for the care that they need to maintain their independence and often their dignity. I share their concerns about patients in need of emergency hospital admission, waiting for hours on trolleys. I am determined that the shortcomings in care will be addressed and improvements forged.
Work towards building the new health and social services has begun. I have ambitious plans for developing our ambulance services and for improving cardiology, and cardiac surgery. I have set out a framework for tackling waiting lists. I have set in motion a review of community care services. I have published proposals for improving the quality of care, and for getting our standards and governance right. Considerable work to improve children’s services is under way.
All of that has been done alongside the vital work of addressing the day-to-day problems, and within the context of severe financial restraint. Building that new Health Service will take time and resources. I inherited a Health Service that had been starved of the investment that it needed to keep pace with services elsewhere. Last week’s Budget announcement was an early, important step in the right direction. The extra funding from it will translate directly into more care packages, more operations, more key staff and more targeted growth in vital areas. However, it is no more than a first step.
One could say that any Minister who inherits a situation in which the population experiences some of the worst health status in western Europe, allied to one of the lowest budgets for health in western Europe, will have a major challenge facing them. Building up our services so that they are able to meet demand is going to require a sustained commitment over a number of years. It is that long-term commitment to underpin the action that we in the Health Service are taking that is needed if things are going to be better in the future. I look forward to working collectively with all of my Executive Colleagues and with all Members of the Assembly — as well as with staff throughout the Health Service — to make the improvements that we need, with the resources that we need.

Ms Sue Ramsey: Go raibh maith agat, a Cheann Comhairle. I thank Carmel Hanna for proposing the motion. However, I want to outline why John Kelly and I tabled the amendment, which, we believe, complements Carmel Hanna’s motion. There is a crisis in the Health Service, from children’s services right through to community care and mental health. That has rightly been highlighted during the course of the debate. I also want to commend the Minister of Health, Social Services and Public Safety for being here for the duration of the debate.
Some Members have mentioned the years of underfunding. In England, and in the Twenty-six Counties, both Governments have recognised that billions of pounds will be needed to stabilise their respective Health Services before they can attempt to develop services for the future.
The problem is compounded by the fact that successive British Governments robbed the Health Service of close to £190 million every year. During the years of underfunding there was no debate or long-term plan, and the internal market was created. I welcome this open and honest debate.
However, we need to realise that the Executive and the Committees have to take responsibility for ensuring that there is openness and accountability in the Assembly. Some people have criticised reviews in the Department of Health, Social Services and Public Safety. Are they saying that the community should not have its say, now that we have this openness and accountability? Do they want to go back to direct rule, or are they afraid of accountability?
Some people touched on the boards and trusts. Sinn Féin has said for a long time that boards and trusts must go. However, reality needs to come into play here. The end of boards and trusts will not generate millions and millions of pounds, although it will generate a small amount of money — I do not think that people are thinking that out. The reason that we want the end of the boards and trusts is that they facilitated the internal market. We have to realise —

Mr Roy Beggs: That is a fantasy.

Ms Sue Ramsey: — that the additional money that was announced in the Budget should be welcomed, because it is a positive step. It shows that the Executive as a whole are listening not only to the Minister, but to the Department, to the Committees and to Assembly Members.
While I welcome the money, it still falls £50 million short of the Minister’s original bid. Her words to the Committee for Health, Social Services and Public Safety at that time were to keep the services as they were and not to target any additional pressures on them.
I want to touch on a number of comments that were made by previous Members who spoke. Carmel Hanna, who supported the motion, said that a blank cheque is not the way forward. In no way would I suggest that, and I support Ms Hanna’s thinking behind it. However, there is a need to target and tackle the years of serious underfunding of the Health Service. She and other Members, pointed to the increase in waiting lists, which is alarming, but the Committee took this on board and asked for research to be carried out on the cancellation of outpatient clinics. Nine percent of these clinics were cancelled, and the main reason was that no holiday arrangements had been made for consultants, so that needs to be tackled as well, and we can target waiting lists if there is planning in the acute sector.
It has been said that we should not call for more resources without knowing where the money will go. As a Member of the Committee for Health, Social Services and Public Safety I know where the money should go. As every Member who has spoken has said, that money should go to the new cancer unit, to mental health, to children’s services and to community care. There is a need there for additional money. Arguing that there has been mismanagement of money undermines the argument for additional money. The Chairperson of the Committee for Health, Social Services and Public Safety says that there is a crisis in the fracture unit. I agree with him — we visited the Royal last week — and that brings me to the need for collective responsibility.

Mr Alex Maskey: Will the Member acknowledge that while some Members from the Ulster Unionist party mutter under their breath, a number of their Members in the Westminster Parliament held the balance of power and never once lifted a finger or raised a voice about the way the Health Service and other services here were being destroyed by that same Westminster Government?

Ms Sue Ramsey: I agree totally.

Mr Danny Kennedy: We have heard much from the Member and her party Colleagues about underfunding and mismanagement. To that I align what has been significantly ignored: the cost to the Health Service of 30 years of paramilitary violence. To come up to date, will the Member join with me and condemn the actions of the youth wing of her party who inflicted an extra burden on the Health Service this week in south Armagh?

Ms Sue Ramsey: I gave way for the Member to make a comment, not a speech. I commend the Member for getting that point in. It takes me back to my point about collective responsibility. Dr Hendron mentioned — [Interruption]. You should not throw stones, Danny, you never know what you might hit.

Mr Speaker: Members should conduct business through the Chair, not that I wish the stones to come in this direction.

Ms Sue Ramsey: I hope that Dr Hendron will agree with me about collective responsibility. It is reflected in the fact that the increase in the waiting time for some fracture services happened because some roads and footpaths were not gritted last year. Most problems that the Health Service faces are not under its control, including, for example, cryptosporidium, fuel poverty and the fact that 20% of children live in poverty. I am not trying to diminish the problems in the health sector, but we need a proper debate.
The Committee for Health, Social Services and Public Safety asked a few weeks ago for a meeting with the Office of the First Minister and the Deputy First Minister and also the Minister of Finance and Personnel to discuss the underfunding of the Health Service. We have received no answer. That makes me wonder whether they take the matter seriously. Do they take their commitments in the Programme for Government seriously, or are they just paying lip service to them?
I agree with what Mr Beggs said. He and I sit on the Public Accounts Committee. However, Mr Beggs should calm Mr Dalton down. If he takes a heart attack, it will add to the waiting lists in our hospitals. I also agree with the Minister that the Assembly and the Executive are ready to rise to the challenge. The problem of years of underfunding must be tackled, but the additional money should, in a mature debate, be welcomed. The funding is not sufficient, but I am pleased at the increase in funding for cardiac surgery and children and family services.
Many Members said that finance was not the main issue, before going on to call for more resources for their own area. That is the reason for our amendment; there is a crisis in the Health Service, and we must tackle it. I urge all Members to support the amendment.

Ms Carmel Hanna: I thank all Members for their valuable contributions. I particularly thank the Minister for listening and responding to our concerns. I welcome the Minister’s comments on the ongoing action.
Mr John Kelly spoke about lighting a candle, rather than cursing the darkness. I hope that Members were more constructive than that. He also talked about the lack of resources; we must know exactly what resources are required. Dr Hendron gave some stark, frightening details of the number of people waiting for cardiac surgery and said that a number of people had died waiting for surgery. He talked about accident and emergency waits, neurology and primary care.
Rev Robert Coulter discussed the structures, the number of trusts and the financial wastage of over-administration. He also expressed his concern about pay awards and mentioned the need for a clear strategy and better management. Mr Berry spoke graphically about crisis, disaster and despair that the situation was getting worse. He said that we needed more debate and expressed concern about the hours that junior doctors work and the related safety implications.
Ms Gildernew referred to the link with poverty and the rural issues — [Interruption].

Mr Speaker: Order. I have told Members from time to time that, if they wish to converse, they should do so in the Lobbies.

Ms Carmel Hanna: Ms McWilliams talked about the need for more resources and the problems with delayed discharges. Mr McCartney returned to the theme of collective responsibility. He also discussed the idea of establishing an emergency committee to deal with the situation. Mr Gallagher talked about the need for common sense and the requirement for more decisions and resources. He also said that we needed a clear plan.
Mr Beggs asked what the Department of Health, Social Services and Public Safety does. He talked about the need for more speech therapists and nurses, and the problems caused by the delayed discharge of patients. He highlighted the frustration that that causes. Mr Shannon spoke about community care, the chief executive’s pay rises and agency nurses. He said that we must hold on to and value our health care staff.
Mrs Nelis made an unfortunate attack on the SDLP, and accused us of being party political. I am sorry that she feels that way. I feel strongly about health issues, and three of my party Colleagues are health professionals who have spent years working for the Health Service. I assure the House that we feel passionate about the issues about which we speak, and we are genuinely concerned about the patients. I resent that attack.
Dr McDonnell spoke about the need for good management and efficiency. His contribution was very constructive; he mentioned the shortfalls in funding for rheumatology and neurology and highlighted the importance of primary care and psychiatric care. Usually, psychiatric care is left until the end of a debate, with the result that we do not get around to discussing it. We could have a whole debate on that topic alone.
We have all tried to address the issue collectively, albeit from differing angles. A general theme of the debate was the need to develop a clear strategy and to make more decisions. We acknowledge that there has been a history of underfunding. However, we must ask where our expenditure is being directed at present. No one doubts that the money is allocated to the hospitals and patients. However, there is a concern that we do not have a clear long-term strategy. If we constantly inject funding in an emergency, we are only sticking a plaster on the problem, rather than getting to the core of it.
In January, £14·5 million was allocated, and in February a further £18 million was allocated. Of that, £8 million was allocated for the work plan on the waiting lists. I would genuinely like to know what happened to that report, because the waiting lists are getting longer.
Northern Ireland does not have an official GDP, and our allocation from the Treasury is made according to the Barnett formula. However, within three years, the UK’s expenditure on health will be 7·6% of the GDP, by comparison with an anticipated EU average expenditure of between 8% and 9%. In general, a higher proportion of the UK’s GDP must be spent on healthcare. The Labour Government have committed themselves to meeting that aspiration. However, money is not the only problem. There is no direct correlation between the amount of money that some countries spend on health and their outcomes.
The UK’s public health expenditure is about the same as Italy’s; it is greater than Spain’s, and it is only 1% behind that of France. We can learn a good deal from other countries. As I said, Northern Ireland spends more than 40% of the block grant on health and social services. For 2002-03, we have allocated £2·527 billion. That is a substantial sum. The Minister of Finance and Personnel noted, rightly, that the Health Minster was successful in well over half of her bids for the discretionary initiatives that she wanted to undertake. In other words, resources are a problem, but they are not the only problem.
We need to get off the merry-go-round of reviews and consultations. We must make some tough decisions, and we need a clear strategy. The patients are crying out for it. I look forward to working with the Minister and the Health Committee and to playing my role in contributing to a better future for the Health Service.
Question, That the amendment be made, put and agreed to.
Main Question, as amended, put and agreed to.
Resolved:
That this Assembly urges the Minister of Health, Social Services and Public Safety to take urgent action to tackle the current crisis in the Health Service, particularly in view of impending additional winter pressures, and calls on the Executive to make the necessary resources available to alleviate pressures throughout the Health Service.
Adjourned at 6.30 pm.